SARS的X线表现

Radiographic Features of Severe Acute Respiratory Syndrome

目的 总结严重急性呼吸综合征 (SARS)早期X线和CT的特征表现及诊断意义。方法 对 82例临床确诊的 1周内SARS病例的数字式正侧位X线胸片对比CT所见进行回顾性分析总结。结果 X线胸片分为 7种类型 :正常或局限性肺纹理粗重型 4例 (4 .9% ) ;棉絮样渗出型 48例 (5 8.5 % ) ;假性空洞型 5例 (6.1% ) ;叶段实变型 12例 (4 .6% ) ;多灶肉芽肿型 3例 (3 .7% ) ;弥漫渗出型 3例 (3 .7% ) ;混合型 7例 (8.5 % )。累及一侧肺 5 7例 (70 % ) ,两侧同时受累 2 5例 (3 0 % )。单发病变 5 2例 (63 .4% ) ,单肺、双肺双发或多发 3 0例 (3 6.6% )。有局灶性病变的患者中 ,位于肺门周围或呈中央分布者2 2例 ;位于外围或胸膜下者 3 2例。病变在 3cm者以上者 62例。累及肺上叶者 3 2例 (右侧 19个、左侧 13个 )、右肺中叶 12例和肺下叶 3 8例 (右侧 2 0个、左侧 18个 ) ,其中 3 0例呈多肺叶的双发或多发病变。 14例患者行HRCT检查 ,均有阳性表现 ,其中 4例在X线胸片上未见明显异常。结论 肺部浸润病灶是SARS的重要影像表现 ,具有复杂多样性 ,其中多灶肉芽肿及假性空洞征象可能是较特异的X线征象。HRCT能够显著提高SARS早期病变的检出率。追踪观察胸部X线的变化是观察疗效的重要指标。

Objective To retrospectively analyze the X-ray and CT features of 82 patients with severe acute respiratory syndrome (SARS) at the early stage.Methods PA and lateral view of the X-ray examinations were performed in 82 SARS patients within the onset of 1 week.Fourteen of them also had CT examinations.Results There were 7 types of X-ray features: normal or locally enhancement of the lung markings in 4 cases (4.9%),cloudy infiltration in 48 cases (58.5%),pseudo-cavity in 5 cases (6.1%),lobar or segmental consolidation in 12 cases (4.6%),multiple granulomas in 3 cases (3.7%),diffuse infiltration in 3 cases (3.7%),mixed lesion in 7 cases (8.5%).57 patients had unilateral lung field involved (70%),and the other 25 patients (30%) had bilateral lung fields involved.52 patients (63.4%) had solitary lesion,whereas 30 patients (36.6%) had multiple lesions.In patients with localized lesions,22 cases had lesions adjacent to the hilum or distributed medially,32 cases had lesions distributed laterally or under the pleural.62 cases had lesions larger than 3cm.The upper lobes were involved in 32 patients (right 19,left 13),the right middle lobe was involved in 12 cases,the lower lobes were involved in 38 cases (right 20,left 18),and 30 patients had multiple lesions.14 patients had high resolution CT examinations,all of them had positive appearances.It should be pointed out that 4 of them had no obvious abnormal appearances in X-ray films.Conclusion The infiltration lesions in the lung field was the important imaging features of the SARS.They varied greatly and the multiple granulomas and pseudo-cavity might be the characteristic X-ray features.HRCT could detect more lesions than the X-ray film.Following-up of the X-ray films could give information of treatment effectiveness.