液氨吸入性肺炎损伤的影像学表现及动态观察  

Imaging findings and follow-up observation of aspiration pneumonia injury caused by liquid ammonia poisoning

作　　者：赵洪全[1] 孔丽丽[1] 程永远[2] 孙海成[2] 

机构地区：[1]烟台经济技术开发区医院影像科,山东烟台264006 [2]烟台市莱阳中心医院放射科,山东莱阳265200

出　　处：《中国临床医学影像杂志》2015年第3期170-174,共5页Journal of China Clinic Medical Imaging

摘　　要：目的:回顾分析急性氨中毒所致吸入性肺炎损伤的影像学表现,探讨病变的演化过程。资料与方法:一次事故致30例健康青年人急性氨中毒吸入性肺炎,男9例,女21例。对伤者的所有胸部影像资料进行回顾,重点对19例中、重度中毒者的CT影像表现进行动态比较分析。结果:本组30例伤者,轻度中毒11例(36.7%),X线主要表现为肺纹理增多模糊,均在7 d内治愈出院,10月后CT复查未见异常。中度中毒10例(33.3%),急性期CT主要表现:支气管血管束增粗模糊10例,小片状影4例,树芽征1例与上述小片状影同时存在。临床治愈出院3月后CT复查,6例无异常发现,4例局部显示轻度间质纤维化征象。9例(30%)重度中毒者2月内,6例表现为细支气管肺泡炎的征象,可见大小不等的斑片影,毛玻璃密度影(GGO)和"马赛克征";2例表现为细支气管损伤性炎症并阻塞的征象,表现为弥漫分布的"树芽征"等,并很快形成坏死性空洞;1例表现为多发肺组织破坏,空洞形成,同时并发气胸、液气胸、皮下及纵隔气肿等。3月后病变慢性化,斑片影、"树芽征"等逐渐吸收,气胸、皮下及纵隔气肿吸收减少,厚壁空洞逐渐演变为空腔样病变,但GGO和"马赛克征"吸收缓慢。结论:液氨吸入性肺炎病变多样,重度中毒损伤有复杂的病变演化过程,CT对肺内病变的观察有较重要的价值。Objective： To retrospectively analyze imaging manifestations of aspiration pneumonia caused by acute ammonia poisoning and investigate its changing process. Materials and Methods- In an accident, 30 healthy young people suffered from acute ammonia poisoning （9 males and 21 females）. All the chest imaging data were reviewed, and special emphasis was put on follow-up CT imaging manifestation of 19 moderate to severe cases. Results： Of the 30 cases, 11 mild poisoning （36.7%） were cured in seven days. Pulmonary texture became increased and fuzzy from their X-ray examinations and there were no abnormality on follow-up CT images after 10 months. For 10 cases of moderate poisoning（33.3%） in acute phase, CT images showed fuzzy broncho-vascular markings in 10 eases, spotty shadows in 4 cases, and tree-in-bud sign with small lamellar shadows in 1 case. After 3 months, the results of CT manifestations were no abnormal findings in 6 eases, local mild fibrosis in 4 cases. For 9 cases （30%） of severe lung injury within 2 months, 6 cases showed signs of alveobronchiolitis with patchy shadows varying in size, ground glass opacity（GGO） and ＂mosaic＂ sign. Two cases showed signs of bronchiolar inflam- mation and obstruction, which was characterized by diffuse distribution of ＂tree-in-bud＂ and quick formation of necrotic cavi- ty. One case showed multiple lung tissue injuries and formation of necrotic cavities, complicated with pneumothorax, liquid pneumothorax, subcutaneous and mediastinal emphysema etc. After 3 months, lung injuries became chronic. Small shadows and ＂tree-in-bud＂ were absorbed gradually. Pneumothorax, subcutaneous and mediastinal emphysema were reduced. The cavum took the place of thick wall cavities. But the absorption of GGO and ＂mosaic sign＂ took a long time. Conclusion： Varied manifestation could occur during aspiration pneumonia owing to liquid ammonia poisoning with complex changes in severe cases. CT imaging manifestations played an important role in observing lung

关 键 词：肺炎 吸入性 体层摄影术 螺旋计算机 放射摄影术 

分 类 号：R563.1[医药卫生—呼吸系统] R814.42[医药卫生—内科学]