脓毒性肺栓塞的多层螺旋CT诊断 - 第三军医大学学报.DOC

脓毒性肺栓塞的多层螺旋CT诊断 韦建林 郭兴 莫婧 董刚志 李炳灿（广西医科大学第四附属医院放射科 广西柳州 545005） 【摘要】 目的 探讨脓毒性肺栓塞的MDCT表现，以提高对本病的认识。方法 回顾性分析12例脓毒性肺栓塞MDCT表现并与X线胸片比较。结果 所有12例患者，X线胸片和CT表现结节（／2）、（／）、空洞（／）、楔阴影（／）、局灶浸润影（／）及胸膜病变（／）／。病灶分布在外周或胸膜下（／2）T较X线胸片可更清晰地显示病灶。结论 脓毒性肺栓塞的CT表现多样，且常为非特异性影像学征象。如存在脓毒性肺栓塞易患因素，出现发热，同时CT显示肺周边多发的结节影，伴有或者不伴有空洞形成以及滋养血管征、胸膜下楔形阴影MDCT diagnosis of Pulmonary Septic Embolism（Wei Jianlin，Guo Xing， Jing ，. Radiology Department， the Fourth Affiliated Hospital of Guangxi Medical University， Liuzhou，Guangxi 545005，China） [Abstract] Objective To study the MDCT manifestations of septic pulmonary embolism（SPE）in order to get a better understanding of the disease. Methods The MDCT findings of 12 patients with septic pulmonary embolism were retrospectively analyzed and compared with Chest radiographs. Results Of the 12 patients, Chest radiographs and CT manifestations were multiple peripheral pulmonary nodules(8/12), a feeding vessel sign(0/9), cavitations(6/10) and wedge-shaped peripheral lesions(4/7),focal infiltrates(2/4), air cyst(2/5), pleural lesions(3/6), hilar/mediastinal lymphadenopathy(0/3). Peripheral or subpleural zones were most commonly affected (8/12) , CT was more useful and revealed nodules or a feeding vessel sign. Conclusion We conclude that SPE presents with variable and often nonspecific clinical and radiographic features. The diagnosis is usually suggested by the presence of a predisposing factor, febrile illness, and CT findings of multiple, nodular lung infiltrates peripherally, with or without cavitation and wedge-shaped peripheral lesions ,a feeding vessel sign. [Keywords] Sepsis，Pulmonary embolism；Tomography，X-ray computed 脓毒性肺栓塞（Septic Pulmonary Embolism ，SPE）是一种不常见的疾病，起病隐匿，表现为发热、呼吸系统症状和肺内浸润影1-2】。由于就诊时临床和影像学征象多为非特异性，因此常延误诊应用毒品盆腔血栓静脉炎GE 16-row Lightspeed螺旋CT胸部扫描，扫描范围自肺尖至肺底，～～重建观察肺窗宽～HU，-600～HU，纵隔窗宽为300～40HU，～50HU。～83.3%），2例有气液平面；一支血管直接伸入结节或沿结节边缘走行，即滋养血管征9例（75%），MPR、MIP显示有些为肺静脉；胸膜下楔形阴影7例（58.3%）；胸腔积液或脓胸6例（50%）；气囊5例（41.7%）；局灶性浸润4例（33.3%）；纵隔/肺门淋巴结肿大3例（25%）。（图1-12） 4例患者X线