肝肺综合征22例临床表现及CT特征分析  

Clinical manifestations and radiological features of hepatopulmonary syndrome

作　　者：李国[1] 施举红[1] 陆慰萱[1] 

机构地区：[1]中国医学科学院北京协和医院呼吸科,100730

出　　处：《中华结核和呼吸杂志》2009年第12期919-922,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的探讨肝肺综合征（HPS）的CT表现并结合临床分析其误诊原因。方法收集1996年11月至2008年11月北京协和医院22例HPS患者，对其CT表现、临床资料进行回顾性分析。结果22例患者中男12例，女10例，平均年龄（44±17）岁，平均病程（54±52）个月。22例患者均行胸部CT扫描，其中10例肺血管束远端分支明显增粗、增多，表现为胸膜下小结节、网格状或片状影；3例仅见双肺基底部段及亚段肺动脉分支增粗；1例表现为中心肺动脉增粗，1例为右心室增大，1例双侧胸腔积液；6例未见异常。19例患者行螺旋CT肺动脉造影（CTPA）三维重建和肺动脉造影（PAA），其中4例肺内血管异常扩张，15例未见异常。同时可见弥漫性肝病12例，其中10例呈肝硬化表现，2例肝脏弥漫增大；食管静脉曲张和（或）胃底静脉曲张12例、脾大6例，腹水3例。结论CT异常影像改变和临床表现相结合，更有利于HPS的诊断。对HPS临床表现及影像特点的了解，有助于减少漏诊、误诊率。Objective To investigate the clinical and radiological features of hepatopulmonary syndrome（HPS）. Methods Twenty two cases diagnosed as HPS in Peking Union Medical College Hospital from Nov, 1996 to Nov,2008 were reviewed. Their clinical features and radiological findings were analyzed. Results The study included 12 males and 10 females with a mean age of （44 ± 17） years and mean course of （54 ±52 ） months. Abnormalities on chest CT scans were found in 12 cases, which included intrapulmonary artery dilatation in 10 cases, with subpleural small nodular, reticular and patchy opacities; bilateral lower basal segmental artery dilatation in 3 cases; main pulmonary artery dilation in 1 case; right ventricular enlargement in 1 case and bilateral pleural effusion in 1 case. The chest CT was normal in 6 cases. CTPA and pulmonary artery angiogram were performed in 15 cases and artery dilatation was found in 4. Diffuse liver diseases were found in 12 cases by CT scans, 10 of them presented as typical hepatic cirrhosis and 2 cases as liver hepatomegaly, while esophagus varix and（or） fundus gastricus varix were found in 12 cases and splenomegaly in 6 cases, hydroperitonia in 3 cases. Conclusion Clinical manifestations combined with CT features were helpful for the diagnosis of HPS.

关 键 词：肝肺综合征 体层摄影术 X线计算机 

分 类 号：R563[医药卫生—呼吸系统] R816.4[医药卫生—内科学]