高原肺水肿CT影像及病理对照  

Comparative study of CT radiopathology of high altitude pulmonary edema

作　　者：王玮[1] 陈辉武[2] 魏经国[1] 王劲武[2] 巩丽[3] 陆洲[1] 刘自辉[2] 赵耀[2] 谭建[2] 

机构地区：[1]第四军医大学唐都医院放射科,陕西西安710038 [2]西藏军区总医院放射科,西藏拉萨850003 [3]第四军医大学唐都医院病理科,陕西西安710038

出　　处：《第四军医大学学报》2005年第4期363-367,共5页Journal of the Fourth Military Medical University

摘　　要：目的:探讨高原肺水肿(HAPE)CT影像特征及其 病理基础.方法:32例HAPE,35例小叶性肺炎患者纳入观 察.采用胸部常规与薄层CT扫描,连续观察病程各期征象表 现及变化.收集经尸检证实HAPE肺组织标本6例.肺门水平 冠状切开全肺,在内中外三带、上中下三野连续取材,观察与 CT相对应结构的病理变化.结果:①32例HAPE中28例右 肺病变重于左肺,35例小叶性肺炎仅有14例(P<0.01); ②HAPE早期(32/32)和恢复期(25/32)以肺间质异常表现为 主.进展期(30/32)与稳定期(32/32)以肺实质病变为主; ③病程中肺实质表现从磨玻璃样变逐渐过渡到结节样实变 再到结节融合呈大片实变;④病理检查见肺泡腔充满水肿液 及数量不等的纤维素、红细胞、炎细胞.肺泡隔增宽,小血管扩 张淤血.3例见纤维蛋白透明血栓,4例有肺透明膜形成,5例 有灶性或片状出血.结论:CT检查可发现HAPE早期病例。AIM: To explore the CT radiological features and the pathology of the high altitude pulmonary edema (HAPE).METHODS: Thirty-two patients with HAPE and 35 patients with lobular pneumonia were included in this study.The manifestations and changes of different stages of the course were observed continuously with regular chest CT and thin layer CT.The pulmonary tissue samples were collected from 6 subjects,whose HAPE-caused deaths were confirmed by autopsy.The lung was incised coronally at the hilum level and the samples were taken from the internal,central and external zones including the upper,middle and lower dimensions in sequence.The pathological changes were then compared between the pulmonary samples and the HRCT images of the same tissue structure.RESULTS: Twenty-eight of the 32 patients with HAPE demonstrated significant pathological changes in their right lungs while only 14 of the 35 patients with lobular pneumonia did (P<0.01) .In the early and recovery stages of AHAPE,the subjects mainly showed abnormal interstitial tissues in the lungs (32/32 and 25/32,respectively) while in the developing and stable stages,the consolidation of the lung tissue was the main manifestation (30/32 and 32/32,respectively).The manifestation of the consolidation in the course of HAPE developed gradually from “grounded-glass” appearance in the lobules to nodular consolidation,and then to large area consolidation.Pathological examination showed the exudates along with fibril,erythrocytes and inflammatory cells in the alveoli and with broadened inter-alveolar space and stasis of blood in the dilated capillaries.Three subjects showed fibrin embolus,4 subjects had transparent membrane formation in the lungs and 5 subjects demonstrated patchy or localized bleeding.CONCLUSION: The early stage of HAPE can be detected with the CT scan,which can also accurately determine the course of the disease and assess the treatment effects.

关 键 词：高原病 肺水肿 体层摄影术 X线计算机 病理学 

分 类 号：R814.42[医药卫生—影像医学与核医学]