医学常见的急性呼吸窘迫综合征(ARDS)的影像学表现.pptVIP

ARDS 病变分布不均匀性 女，29岁，产后，突发憋气、咳血、体温不高、血象正常，血氧饱和度不吸氧80，吸氧后95，听诊右肺无明显湿性罗音，左肺可闻湿罗音，强心利尿3日后病变明显吸收 心源性肺水肿 上例病人，治疗后 再看这一例 女，51岁。突发咳血，伴肾功能不全 肺肾综合征 Goodpasture syndrome(G P S) GPS 治疗后病变吸收 女，59。高血压、糖尿病肾病 胸片所见： 心脏增大、肺水肿、奇静脉扩张、间隔线、支气管周袖口征 女，24岁，产后心悸胸闷， 超声诊断心肌病。 治疗心衰一周后复查 Imaging of Acute Respiratory Distress Syndrome RESPIRATORY CARE ? APRIL 2012 V OL 57 N O 4 Fig. A: Chest radiograph of patient with ARDS shows bilateral infiltrates. There is bilateral consolidation and a right pleural effusion. B: Chest radiograph of the same patient shows persistent bilateral infiltrates after 7 days. A）ARDS双侧肺侵润，右侧胸膜渗出 B）7天后，持续性双侧肺侵润 Fig. 2. Computed tomogram of a patient with ARDS shows bilateral dense dependent consolidation, with areas of ground-glass opacification and normal lung in the non-dependent lung. Fig. 3. Computed tomogram in ARDS shows bilateral reticulation and ground-glass opacification, containing areas of bronchial dilatation in the upper lobes. In the acute phase of ARDS, bronchial dilatation may indicate fibrosis or may be reversible. 图2 ARDS病人，双侧重力依赖区显著实变；而磨玻璃密度区及正常肺在非重力依赖区。 图3 ARD病人，双侧网格状及磨玻璃密度，其上叶病变内含支气管扩张。在ARDS的急性期出现支气管扩张，可提示纤维化，或为可逆性。 Computed tomogram of the mid zones of a patient with ARDS shows bilateral ground-glass opacification. Note the presence of non-dependent consolidation in the right lower lobe，which raises the possibility of superadded infection.The esophageal stent is incidental. ARDS：显示双侧肺磨玻璃密度；注意，右下肺非重力依赖区的实变，可能为继发性感染。 A: Computed tomogram shows bilateral dependent consolidation in a patient with ARDS, as well as ground-glass opacities in the non-dependent lung. B: Follow-up computed tomogram after 1 year shows resolution of the consolidation and ground glass opacification with cyst formation in the anterior left lung. 图A ARDS病人，CT显示双肺重力依赖区实变，以及在非重力依赖区肺野的磨玻璃影。 图B 同一病人在1年后的随访显示实变和磨玻璃影消散，伴左肺前部囊肿形成。 How large is the lung recruitability in early acute respiratory distress syndrome: a prospective case series of patients monitored by computed Tom