32例重型和危重型新型冠状病毒肺炎胸部影像学分析  

Chest radiological analyses of 32 patients with severe and critical patterns of COVID-19

作　　者：张娜 陈志凡[2] 肖建明[2] 王新伟 江敏 谢利秋 高月琴 ZHANG Na;CHEN Zhi-fan;XIAO Jian-ming;WANG Xin-wei;JIANG Min;XIE Li-qiu;GAO Yue-qin(Department of Radiology,Chengdu Public Health Clinical Medical Center,Chengdu 610061,China;Department of Radiology,The Affiliated Hospital,Chengdu University,Chengdu 610081,China)

机构地区：[1]成都市公共卫生临床医疗中心放射科,四川成都610061 [2]成都大学附属医院放射科,四川成都610081

出　　处：《实用医院临床杂志》2020年第2期31-34,共4页Practical Journal of Clinical Medicine

基　　金：成都市科学技术局项目(编号:2020-YF05-00034-SN)。

摘　　要：目的探讨新型冠状病毒肺炎(COVID-19)重型和危重型患者的胸部影像学特点。方法回顾性分析2020年1月16日至2020年2月22日成都市公共卫生临床医疗中心确诊的32例COVID-19重型和危重型患者的影像学检查资料,分析DR和CT影像学特征。结果32例COVID-19重型和危重型患者,共行80次CT检查、167次DR(床旁)检查,4例未行CT扫描,7例未行DR检查。其中,161次DR床旁表现为累及双肺的多发局限性斑片状阴影或者多发实变阴影,118次DR表现为明显双侧不对称性分布,肺野外周分布显著84例次,2次DR表现为“白肺”。80例次CT检查资料中,主要表现为磨玻璃密度阴影(ground-glass opacity,GGO)46例次和GGO重叠间质性网线阴影22例次,其内有增粗的血管阴影61例次,小叶内间质增厚31例次,晕征67例次,反晕征58例次,完成CT扫描的28例最少累及3个肺叶、5个肺段;双侧不对称性分布76次,以胸膜下分布为主67例次。结论COVID-19重型和危重型主要表现为累及双肺的不对称性分布的不均匀密度增高阴影,CT以累及多叶(至少3叶)多段(大于5个肺段)多发的、以外周胸膜下分布为主的混杂密度GGO(mixed GGO,mGGO)和小叶内间质增厚为主的间质性网线或者间质性网线小结节阴影。床旁DR不作为COVID-19重型和危重型的影像学初诊或者筛查主要手段,但是对确诊患者短期复查评估病变范围的动态变化可以作为主要影像学检查工具之一;CT是重型和危重型的基本影像学诊断工具。Objective To explore radiological characteristics of patients with several and critical corona virus disease 2019(COVID-19).Methods Radiological data of 32 patients diagnosed as severe and critical pattern of COVID-19 in Chengdu Public Health Clinical Medical Center(CPHCMC)from January 16 to February 22,2020 were retrospectively analyzed to show their imaging features of DR and CT.Results A total of 167 bed-sides DR and 80 chest CT scanning was performed.However,there were 4 cases without CT data and 7 cases without DR data.In 161 DR data,there were 118 images showing obvious bilateral asymmetry distribution,84 images showing peripheral prominence distribution and 2 images showing“white lung”.In 80 CT data,images were manifested as ground-glass opacity(GGO)pattern in 46 images,and GGO overlapped by intestinal reticulolinear pattern was found in 22 images.Further,thickened vascular prominences noted was found in 61 images,intralobular intestinal thickening in 31 images,and halo sign in 67 images as well asreversed halo sign in 58 images.In 28 cases of complete CT scan,at least 3 lobes or 5 segments were involved,and asymmetric distribution on both sides were found in 76 CT data and sub-pleural prominence were found in 67 CT data.Conclusion COVID-19 in severe and in critical pattern presents as bilateral asymmetric distributed uneven opacities with peripheral sub-pleural prominence in mixed GGO(mGGO)patterns or in reticulolinear pattern of intra-lobular intestinal thickening or in reticulo-linear-nodular pattern.Bed-sided DR could not be a major technique for initial diagnosis or screen of severe and critical pattern of COVID-19 but is one of image examinations to assess the dynamic changes of the disease in the short-term reexamination in confirmed patients.On the other hand,CT is the basal investigation manure for COVID-19 in severe and in critical pattern.

关 键 词：新型冠状病毒肺炎 磨玻璃密度阴影 CT 

分 类 号：R563.1[医药卫生—呼吸系统] R445[医药卫生—内科学]