支气管胸膜瘘的多层螺旋CT征象分析

The multi-detector CT features of bronchopleural fistula

目的:探讨支气管胸膜瘘(BPF)的多层螺旋CT征象。方法:回顾分析我院CT确诊的44例BPF患者的临床、影像资料。44例患者中,32例行胸部CT平扫及增强扫描,12例仅行胸部CT平扫。结果:44例BPF患者中,30例有胸部手术(30/44,68%)。中央型BPF 21例(21/44,48%),CT上均能显示瘘口位置;外周型BPF 21例(21/44,48%),19例可显示瘘口,2例瘘口显示不清;混合型2例(2/44,4%),瘘口均能显示。28例存在1个瘘口;14例存在2个及2个以上瘘口。瘘腔最大径17~123 mm,平均(69.4±26.89) mm,瘘腔内壁光滑19例,不光滑25例;瘘腔内分隔20例;瘘腔内低密度结节12例,增强后均未见强化,其中6例证实合并曲霉菌感染,1例合并龋齿放线菌感染;瘘腔内条片状、条索状影7例,其中4例证实合并曲霉菌感染;瘘腔内少量积液31例。所有病例均合并胸膜增厚,胸膜增厚呈均匀或不均匀,厚约5~18 mm,平均(13.0±3.45) mm;13例胸膜出现钙化,呈斑片状、条索状(13/44,30%)。21例治疗后有随访,其中保守治疗11例(11/21,52%),治疗后改善5例,加重2例,无变化4例;手术(封堵器封堵和/或外科手术)治疗10例(10/21,48%),其中病灶改善5例,加重4例,无变化1例。结论 :支气管胸膜瘘是肺部手术或结核感染的严重并发症,当术后患者出现胸膜增厚、残腔内分隔及积液时,需多平面重建仔细观察支气管是否与胸膜腔直接沟通,以明确BPF的诊断,若残腔内出现低密度结节或不规则条索、条片状阴影,需注意有无合并感染,尤其是曲霉菌感染。

Objective:To investigate the multi-detector CT(MDCT)features of bronchopleural fistula(BPF).Methods:The clinical and imaging data of 44 patients with BPF diagnosed by CT in our hospital were retrospectively analyzed.Among the 44 patients,32 underwent plain and enhanced chest CT scans,and 12 underwent plain chest CT only.Results:Of the 44 patients with BPF,30 had thoracic surgery(30/44,68%).In 21 cases of central type BPF(21/44,48%),the position of the fis-tula opening could be found on CT,in 21 cases of peripheral type BPF(21/44,48%),of which 19 cases of the fistula opening could be found,2 cases were not clear,and in 2 cases of mixed type BPF(2/44,4%),the position of the fistula opening could be found.Twenty-eight cases had one fistula opening,14 cases had two or more fistula opening.The maximum diame-ter of the fistula cavity was 17~123 mm,with an average of(69.4±26.89)mm.The inner wall of the fistula cavity was smooth in 19 cases and not smooth in 25 cases.There were 20 cases with separation in the fistula cavity,12 cases of low-density nodules in the fistula cavity showed no enhancement after enhancement,of which 6 cases were confirmed to be complicated with aspergillus infection and 1 case with actinomycete caries infection.There were 7 cases of flake and cord shadow in the fistula cavity,of which 4 cases were confirmed to be complicated with aspergillus infection.There were 31 cases with a small amount of effusion in the fistula cavity.All cases were complicated with pleural thickening(uniform or non-uniform).The thickness was about 5~18 mm,with an average of(13.0±3.45)mm.Thirteen cases had pleural calcification(patchy or cord-like)(13/44,30%).Twenty-one cases were followed up after treatment,of which 11 cases(11/21,52%)were treated conservatively(5 cases were improved after treatment,2 cases were aggravated,and 4 cases was unchanged)and 10 cases(10/21,48%)under-went surgery(occluder occlusion and/or surgery),of which 5 cases were improved,4 cases were aggravated,and 1 case was unchanged).Conclusion:Bronchopleural fistula is a serious complication of pulmonary surgery or tuberculosis infection.When postoperative patients have pleural thickening,residual cavity separation and effusion,multi-planar reconstruction is required to carefully observe whether the bronchus is in direct communication with the pleural cavity to determin the diagnosis of bron-chopleural fistula.If there are low density nodules or irregular cords or patchy shadows in the residual cavity,it is necessary to pay attention to whether there is any concurrent infection,especially aspergillus infection.