人感染H7N9禽流感病毒性肺炎的胸部X线与CT影像学表现及特征分析  

Analysis of features of thoracic radiography and CT in pneumonia caused by human H7N9 subtype avian influenza virus infection

作　　者：吴炅[1] 孔俊沣[1] 何泽清[1] 刘兴华[1] 高才良[1] 牟桂香 WU Jiong;KONG Junfeng;HE Zeqing;LIU Xinghua;GAO Cailiang;MOU Guixiang(Radiology Department of Chongqing Three Gorges Center Hospital,Chongqing 404000,P.R.China)

机构地区：[1]重庆三峡中心医院放射科

出　　处：《医学影像学杂志》2019年第5期770-774,共5页Journal of Medical Imaging

摘　　要：目的探讨人感染H7N9禽流感病毒性肺炎的胸部X线与CT影像学表现及动态变化的特征。方法收集本院6例经临床确诊为人感染H7N9禽流感患者的临床和影像学资料,对其胸部X线与CT影像学表现行回顾性分析。结果3例患者早期病灶位于一侧肺下叶或双肺下叶,6例进展期均表现为双肺多叶多段的弥漫性病变,并且右肺病变比左肺严重,双肺下叶及后部病变较上叶及前部严重。肺部病变以磨玻璃影及实变影为主。实变病灶内可见空气支气管征。1例患者出现小叶中心型结节。1例可见小叶间隔增厚。2例患者肺部出现空洞病灶,其中1例空洞内可见典型曲菌球及空气新月征,患者痰培养证实黄曲霉菌感染,另1例痰培养提示泛耐药脑膜脓毒性黄杆菌感染。5例在恢复期肺部出现条索影及网格影。1例死亡患者在后期胸片表现为典型双侧白肺表现,并出现纵隔、双侧胸壁、颈肩部广泛积气,几天后又出现一侧大量气胸。1例患者前纵隔少许积气。6例进展期均出现浆膜腔少量积液,3例纵隔多发淋巴结增大。结论人感染H7N9禽流感病毒性肺炎肺部病灶变化快,发病3~7天可迅速进展为双肺多叶多段弥漫性病变。早期病灶常位于一侧肺下叶或双肺下叶,进展期右肺病变常比左肺严重;双肺下叶及后部病变较严重,有沿重力分布的特点。肺部病变以磨玻璃影及实变影为主;常合并其他病原菌感染,令影像学表现复杂多样;双侧白肺提示病变恶化。进展期常出现浆膜腔少量积液,部分出现纵隔淋巴结增大,可出现气胸、纵隔积气、皮下气肿等气压伤表现。恢复期较长,表现为肺间质纤维化改变。Objective To investigate the features and dynamic changes of thoracic X-ray and CT imaging in pneumonia caused by human H7N9 subtype avian influenza virus Infection.Methods The clinical and imaging data of 6 patients with H7N9 avian influenza in the hospital were collected,and their thoracic X-ray and CT imaging findings were retrospectively analyzed.Results The early lesions in 3 patients were located in lower lobes of one lung or both lungs.In progressive stage,all 6 patients showed diffuse lesions in multiple pulmonary lobes and segments of double lungs.In addition,the lesions in right lung was more serious than left,and the lesions in lower lobe and posterior focus of double lungs were more serious.The lung lesions were mainly ground-glass opacities and consolidation.Air bronchogram was seen in the consolidation.The central nodules of lobule were found in 1 patient.The thickening of interlobular septum was found in 1 case.There were cavity lesions in the lungs in 2 cases.Among them,typical aspergillballs and air crescent signs were found in the cavities in 1 case.Sputum culture confirmed Aspergillus flavus infection,and phlegm culture of the other case suggested pyonicytobacillus Flavobacterium infection.There were 5 cases with pulmonary linear and reticular in convalescence.1 death case showed typical bilateral white lung in the later thoracic X-ray,and extensive gas accumulation occurred in the mediastinum,bilateral chest wall,neck and shoulder,a few days later,serious pneumothorax appeared on the side.The anterior mediastinum had a little gas accumulation in 1 patient.A small amount of fluid accumulation in the serosal cavity was observed in all 6 cases.Mediastinal multiple lymph nodes in 3 case were enlarged.Conclusion The lung lesions in pneumonia caused by human H7N9 subtype avian influenza virus infection could be rapidly changing,and the onset of 3~7 days could be rapidly progressed to diffuse lesions in multiple pulmonary lobes and segments of double lungs.The early lesions were usually located in lo

关 键 词：禽流感 甲型H7N9病毒 肺炎 体层摄影术 X线计算机 

分 类 号：R561[医药卫生—呼吸系统] R814.42[医药卫生—内科学]