甲型H1N1流感并发急性呼吸窘迫综合征的影像学表现分析  

Analysis of Imaging Findings in Influenza A H1N1 with Acute Respiratory Distress Syndrome

作　　者：谢正平[1] 戴峰[1] 朱西琪[1] 许传军[1] 蒋燕[1] 袁莉莉[1] 李超[1] 

机构地区：[1]东南大学附属第二医院放射科,江苏南京210003

出　　处：《实用放射学杂志》2010年第11期1571-1575,共5页Journal of Practical Radiology

摘　　要：目的 探讨重症甲型H1N1流感并发急性呼吸窘迫综合征（ARDS）的影像学表现.方法 回顾分析12例重症甲型H1N1流感患者并发急性呼吸窘迫综合征（ARDS）的X线和CT表现.X线检查包括普通胸部DR摄片和床边DR摄片,CT检查包括常规螺旋CT扫描和高分辨率CT（HRCT）扫描.结果 （1）X线表现分为初期、进展期、恢复期3期.初期：X线检查发现单发斑片状或云雾状密度影3例.双侧多发病灶9例,其中两下肺多发片状模糊影5例,两上、中、下肺中外带多发节段性片状模糊影2例,右下肺大片实变影,同时左肺出现散在斑片状模糊影1例,两肺门影增浓、模糊,肺门周围分布点片状模糊影1例.进展期：所有病例病灶迅速扩大,表现为多肺段或多肺叶浸润,两肺均受累及,病灶多变,呈现出游走性浸润.恢复期：病灶逐渐吸收,残留有纤维条索影7例,网格状肺纹理2例,栗粒结节影2例,两下肺小片状均匀密度影1例.（2）CT表现：实变影,表现为两肺单发或多发的斑片状或大片状模糊影12例, 支气管充气像8例.磨玻璃样密度影6例.肺间质性改变包括肺纹理呈网格状5例,胸膜下弧线影3例,胸膜下斑片状磨玻璃影5例,小叶间隙增厚4例,这些征象可同时存在.（3）合并症：气胸4例,纵隔皮下气肿4例,腹膜后积气1例,真菌性空洞3例,蜂窝肺1例.结论 重症甲型H1N1流感并发ARDS影像学表现复杂、多变,并发症多,影像学检查能及时准确地显示甲型H1N1流感并发ARDS各阶段的病变过程,有利于指导和评估临床治疗效果.Objective To discuss the imaging patterns of severe influenza A HIN1 with acute respiratory distress syndrome （ARDS）.Methods X--ray and CT findings of 12 patients suffered from severe influenza A H1N1 with acute respiratory distress syndrome were retrospectively analyzed. X-ray examination included ordinary photography and photography beside bed, CT examination included coventional spiral CT scanning and high resolution CT （HRCT） scanning. Results （ 1 ） The feature of X-ray could be divided into early stage, progressive stage and recovery stage. During early stage, X-ray examination found 3 patients with single patching and cloudiness shadows, 9 with multiple lesions in bilateral lungs, 5 with multiple patching fuzzy shadows in bilateral lungs, 2 with multiple segmental patching fuzzy shadows and large consolidation in right lower lung, meanwhile, 1 with interspersed patching fuzzy shadow in left lung, 1 with two hilars to be becoming densify and ambiguity, and had spot and patching fuzzy shadow around the hilar. Progressive stage： the lesions enlarged rapidly in all patients, manifested as multiple pulmonary segments or lobes were infiltrated and bilateral lungs were involved, the lesions were chanceful and showed wandering infiltration. Recovery staged：the lesions were absorbed gradually, fibrous band shadows were residued in 7 patients, 2 had grid lung markings,2 had military nodular shadow. 1 had small uniform patching shadow. （2） The manifestations of CT：the consolidation areas manifested as single or multiple patching fuzzy shadows in bilateral lungs in 12 patients, as inflatable bronchus in consolidated lung in 8, as ground-glass opacity shadows in 6,1obular septa became wide in 4. All these features could exit simultaneously. （3）The complications included：4 with pneumothorax. 4 with subcutaneous emphysema in mediasti-- num,1 with retroperitoneal pneumoperitoneum, 3 with fungal empty, 1 with honeycomb lung. Conclusion The imaging patterns of severe influenza A HIN1 with ARDS are

关 键 词：甲型H1N1流感 急性呼吸窘迫综合征(ARDS) 放射摄影术 体层摄影术 X线计算机 胸部 

分 类 号：R511.7[医药卫生—内科学] R563.8[医药卫生—临床医学]