三峡库区胸肺型肺吸虫病的临床及CT影像表现特点

Analysis Of Clinical Features And CT Image Features of Paragonimiasis in the Three Gorges Reservoir Area

目的探讨胸肺型肺吸虫病的临床特点及CT影像表现。方法搜集2017年12月至2021年12月重庆大学附属三峡医院收治的临床诊断为胸肺型肺吸虫病患者49例,回顾性分析其临床及CT影像资料。结果流行病学史:32例(65.3%)患者发病前有生食溪蟹及海鲜、饮用生水史。临床表现:咳嗽、流涕等感冒症状19例(38.7%),头痛6例(12.2%),腹痛6例(12.2%),胸痛9例(18.4%),发热2例(4.0%),胸闷不适4例(8.2%)。实验室检查:所有患者肺吸虫抗体均为阳性(100%);白细胞计数升高28例(57.1%),最高达42.1×10^(9)/L;嗜酸性粒细胞计数增高40例(81.6%),最高达18.43×10^(9)/L;嗜酸性粒细胞比率升高45例(91.8%),最高达74.6%。CT影像学表现:胸腔积液34例(69.4%),心包积液8例(16.3%),胸膜增厚28例(57.1%);肺内浸润性病变41例(83.7%),位于胸膜下32例(78.0%),病变主要位于下肺30例(73.1%);支气管周围炎12例(24.5%);边缘清晰结节影7例(14.3%),伴钙化影3例(6.1%);肺内单房或多房囊肿9例(18.4%),肺内“隧道样”腔隙及“窟穴样”改变5例(10.2%),结节伴“月晕征”8例(16.3%);条索影12例(24.5%),“蜿蜒条索影”17例(34.7%),“串珠状影”4例(8.2%),病变跨叶间裂9例(18.4%)。结论胸肺型肺吸虫病胸部CT影像常表现为多浆膜腔积液及位于胸膜下或肺边缘的肺内浸润性病变;肺内单房或多房囊肿、肺内“隧道样”腔隙、“蜿蜒条索影”或“串珠状影”及病变跨叶间裂发展对诊断胸肺型肺吸虫病具有提示性意义,结合流行病史阳性、咳嗽等感冒症状、实验室检查嗜酸性粒细胞计数升高时,有提示该病的可能性。

Objective To explore the clinical characteristics and CT image characteristics of lung type paragonimiasis.Methods A total of 49 patients with lung type paragonimiasis diagnosed clinically in Three Gorges Hospital of Chongqing University from December 2017 to December 2021 were collected,and their clinical and CT imaging data were retrospectively analyzed.Results Epidemiological history:32 patients(65.3%)had a history of eating raw crab、seafood and drinking raw water before onset.Clinical manifestations:cough,runny nose and other cold symptoms in 19 cases(38.7%);headache in 6 cases(12.2%);abdominal pain in 6 cases(12.2%);subcutaneous nodules in 7 cases(14.3%);chest pain in 9 cases(18.4%);fever in 2 cases(4%);chest distress in 4 cases(8.2%).Laboratory examinations:all patients had positive paragonimiasis seroantibodies(100%).Leukocytes were elevated in 28 cases(57.1%)with the highest 42.1×10^(9)/L.Eosinophil count was increased in 40 cases(81.6%),up to 18.43×10^(9)/L;Eosinophil ratio was increased in 45 cases(91.8%)and the highest was 74.6%.CT imaging findings:pleural effusion in 34 cases(69.4%);pericardial effusion in 8 cases(16.3%);pleural thickening in 28 cases(57.1%);infiltrating shadows in 41 cases(83.7%),32 cases(78.0%)located in the subpleural,30 cases(73.1%)mainly located in lower lobes;peribronchial inflammation in 12cases(24.5%);clear nodular shadow in 7 cases(14.3%),with calcification shadow in 3 cases(6.1%);cystic shadow in 9 cases(18.4%);tunnel-like cavities in 5 cases(10.2%);nodules with crescent signs in 8 cases(16.3%);strip shadow in 12 cases(24.5%);snake strip shadow in 17 cases(34.7%);beading shadow in 4 cases(8.2%);shadow across the lobes of lung in 9 cases(18.4%),etc.Conclusion The chest CT images of lung type paragonimiasis usually showed multiple serous effusion and infiltrating shadows located in the subpleural or pulmonary margins.Single or multiple cysts,tunnel-like cavities,snake strip shadows or beading shadows and shadow across the lobes of lung have suggestive meaning for the diagnosis of lung type paragonimiasis.Combined with a positive epidemiological history and elevated laboratory eosinophils,the lung type paragonimiasis should be highly suspected.