肺梗死的CT影像诊断

CT imaging diagnosis of pulmonary infarction

目的分析急性肺血栓栓塞症合并肺梗死患者CT影像特点。方法回顾性分析64例急性肺血栓栓塞症合并肺梗死患者的CT影像表现,总结肺梗死的数量、位置、形态、有无胸腔积液等。结果最终纳入急性肺血栓栓塞症386例,其中肺梗死64例,梗死发生率为16.58%。64例肺梗死患者累及双肺上叶血栓数为224(24.62%)个;左舌叶和右肺中叶血栓数为177(19.45%)个;双肺下叶血栓数为483(53.08%)个。共有107个肺梗死灶,41(64.06%)例患者有单个梗死灶,12(18.75%)例患者有两个梗死灶,11(17.19%)例患者有三个或更多梗死灶。4(3.74%)个梗死灶位于左肺上叶固有段,13(12.15%)个位于左肺上叶舌段,左肺下叶有28(26.17%)个;右肺上叶13(12.15%)个,右肺中叶12(11.21%)个,右肺下叶37(34.58%)个。右下叶栓塞发生肺梗死的风险较高(P<0.001)。74(69.16%)个表现为楔形实变影,27(25.23%)个为反晕征,血管征1(0.93%)个,空洞1(0.93%)个,47(43.93%)个出现胸腔积液。不同性别患者的梗死影像特征无明显差异。结论胸部CT表现为单发或多发,胸膜下楔形实变影,内部可见磨玻璃影,可伴有胸腔积液,应考虑到急性肺血栓栓塞症合并发肺梗死可能。这些征象有助于早期识别肺栓塞,以减少漏诊和误诊。

Objective To analyze the CT imaging characteristics of patients with acute pulmonary thromboembolism combined with pulmonary infarction.Methods We retrospectively analyzed CT imaging findings of 64 patients with pulmonary infarction following acute pulmonary thromboembolism and summarized the number,location,morphology,and presence of pleural effusion of pulmonary infarction.Results 386 cases of acute pulmonary thromboembolism were included,including 64 cases of pulmonary infarction,with an incidence rate of 16.58%.In 64 patients with pulmonary infarction,224(24.62%)upper lobe thrombi were involved.177(19.45%)in the left lingual lobe and right middle lobe,and 483(53.08%)in the lower lobe thrombosis in both lungs.There were a total of 107 pulmonary infarction foci,of which 41(64.06%)patients have a single infarction foci,12(18.75%)patients had two infarction foci,and 11(17.19%)patients had three or more infarction foci.4(3.74%)infarcts were located in the intrinsic segment of the left upper lobe,13(12.15%)in the lingual segment of the left upper lobe,and 28(26.17%)in the left lower lobe.13(12.15%)in the upper lobe of the right lung,12(11.21%)in the middle lobe of the right lung,and 37(34.58%)in the lower lobe of the right lung.The risk of pulmonary infarction was higher for the right lower lobe embolism(P<0.001).74(69.16%)showed wedge-shaped consolidation,27(25.23%)showed reversed halo sign,1(0.93%)vascular sign,1(0.93%)cavitation,and 47(43.93%)showed pleural effusion.There was no significant difference in the imaging features of infarction between patients with different genders.Conclusion Typical chest CT findings in pulmonary infarction are peripheral wedge-shaped consolidation with internal air lucencies,with or without pleural effusion.Pulmonary infarction is more common in both lower lobes.These features can help identify pulmonary thromboembolism early to reduce misdiagnosis and missed diagnoses.