重症鹦鹉热衣原体肺炎的早期影像学特征分析

Analysis of Early Imaging Features of Severe Chlamydia Psittaci Pneumonia

目的总结重症鹦鹉热衣原体肺炎的早期影像学表现特点。方法搜集本院2019年1月至2021年3月确诊为鹦鹉热衣原体重症肺炎的10例患者,结合文献分析并总结其临床及早期影像学特征。结果CT检查中10例患者共29个肺叶受累,左肺下叶累及频次最高为7例,7例一侧肺病变分布明显多于对侧。所有患者均有不同程度的肺实变影,实变处全部可见空气支气管征,实变周围可及大小不均磨玻璃影,患侧肺多见肺索条影。所有患者气管及主要支气管通畅。1例患者纵隔可见散在肿大淋巴结,5例患者合并胸腔积液,其中4例为患侧胸腔积液。超声检查中,所有患者患侧肺部“胸膜滑动征”减弱,B线增多,肺组织内边界不清不规则片状低回声,患肺均可见“碎片征”、“支气管充气征”,实变肺组织内可检测到血流频谱。好转患者8例,2例死亡。结论鹦鹉热衣原体肺炎病情重,早期有特征性的“扇形”渗出及实变影像表现,建议结合接触史及二代测序检查确诊。

Objective Summarize the early imaging features of Chlamydia psittaci pneumonia.Methods Screening of 10 patients diagnosed with Chlamydia psittaci pneumonia,which were in our hospitalfrom January 2019 to March 2021,analyzing and summarizing their clinical and early imaging characteristics under literatures.Results 29 affected lung lobes from 10 patients were confirmed in CT,the lower lobe of the left lung has the highest frequency of involvement(n=7),7 cases the distribution of lung lesions on one side was significantly more than that on both sides.Different degrees of lung consolidation were found in all patients,and air bronchial signs were seen in all consolidation sites.Ground-glass shadows were unevenly accessible around consolidation,and lung cord-stripe shadows were more common in the affected lung.The trachea and main bronchus of all patients were unobstructed.Scattered enlarged lymph nodes were seen in the mediastinum of one patient.5 patients had pleural effusion,and 4 of which had effusion on the diseased side.The ultrasound examination showed that,the“pleural sliding sign”of the affected lungs of all patients was weakened,the B-line increased,the inner boundary of the lung tissue was unclear and irregular and sheet-like hypoechoic.The affected lungs showed“fragment sign”and“bronchial inflation sign”.The blood flow spectrum can be detected in the transformed lung tissue.Eight patients improved and two died.Conclusion Chlamydia psittaci pneumonia is in serious condition and is characterized with early imaging manifestations of fan shaped seepage and consolidation.It is recommended to combine contact history and 2nd-generation sequencing to confirm the diagnosis.