文章摘要
陆普选, 曾政, 郑斐群等.人感染H7N9禽流感病毒性重症肺炎的影像学表现及动态变化特点[J].放射学实践,2014,(07):740-744
人感染H7N9禽流感病毒性重症肺炎的影像学表现及动态变化特点
Characteristics of imaging manifestations and dynamic changes in patients with severe pneumonia caused by H7N9 avian influenza virus
  
DOI:10.13609/j.cnki.1000 0313.2014.07.002
中文关键词: 肺炎  病毒性  禽流感  放射摄影术,胸部  体层摄影术,X线计算机
基金项目:深圳市知识创新计划重点项目(JCYJ201304011 64750006);广东省医学科研基金(A2011543)
作者单位
陆普选, 曾政, 郑斐群等 深圳市第三人民医院 
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中文摘要:
      【摘要】目的:探讨人感染H7N9禽流感病毒性重症肺炎的影像学检查方法及胸部X线、CT影像表现及动态变化特点。方法:对17例(男9例,女8例)确诊人感染H7N9禽流感病毒性重症肺炎患者行胸部X线摄片和薄层CT扫描检查,由2名影像学专家对其影像表现及动态变化进行评价分析。结果:①早期病变位于一侧肺下叶15例,位于上肺叶者2例。进展期病变累及双侧肺16例(16/17,94.1%),累及一侧肺叶1例(1/17,5.9%),病变累及4~6个肺叶共16例(94.1%)。②早期和进展期影像学表现见磨玻璃样影和/或肺实变影17例(17/17,100%);13例患者出现胸膜腔积液(13/17,76.5%)。③恢复期主要表现为多发小斑片影(14例)、片状磨玻璃影(9例)、条索状影(16例)及肺气囊(3例)。出院前胸部CT检查以网格状及胸膜下线影(6例)间隔旁肺气肿、瘢痕型肺气肿及纵隔旁胸膜下肺大疱等(4例)为主。2例合并有鲍曼不动杆菌感染,其中1例还合并双侧股骨头缺血坏死。有15例符合最早出现的病灶晚吸收,较晚出现的病灶最早吸收的特点。结论:人感染H7N9禽流感病毒性重症肺炎患者具有明显磨玻璃样影及肺实变表现,病灶以两下叶及背部为著,变化快且广泛,病灶吸收缓慢,恢复期见肺纤维化等特点。影像学的动态观察对指导临床诊断、治疗以及判断预后有一定价值。
      【Abstract】Objective:To study the imaging approaches,characteristics of imaging manifestations and dynamic changes in patients with severe pneumonia caused by H7N9 avian influenza virus.Methods:Chest radiography and thin slice CT scanning were performed in 17 patients with severe pneumonia caused by H7N9 avian influenza virus.The imaging findings and dynamic changes were evaluated and analyzed by two radiology experts.Results:①In early phase,lesions located at unilateral lower lobe (15 cases) or upper lobe (2 cases).In advanced phase,16 patients (16/17,94.1%) had lesions involved bilateral lungs,one patient had unilateral lung involved (1/17,5.9%),lesions involved 4~6 lobes in 16 cases (16/17,94.1%);②In early as well as progressive phase,all patients (100%) showed pulmonary ground glass opacities and/or consolidation;13 patients (13/17,76.5%) had pleural effusion;③During recovery period,lesions mainly manifested as multiple small patchy opacities (14 patients),patchy ground glass opacities (9 patients),linear opacities and pneumatocele (3 patients).14 patients had chest CT examinations before discharge,lesions mainly manifested as reticular and subpleural linear opacities,paraseptal emphysema,scar emphysema,para mediastinal and subpleural bullae.2 patients complicated with Bauman Acinetobacterial infection,of which one case also complicated with bilateral avascular necrosis of femoral head.15 patients showed the earliest appeared lesions yet absorbed the latest,and vice versa.Conclusion:Patients with severe pneumonia caused by H7N9 avian influenza virus had the imaging features as marked pulmonary ground glass opacities and consolidation and mainly located at lower lobes and dorsal aspect of lung,fast changing and rapid spreading of lesions with slow absorption,pulmonary fibrosis could be seen at the recovery period.Dynamic observation of imaging features played a significant role in clinical diagnosis,treatment guidance and prognosis prediction.
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