胸部CT显示梗阻性肥厚型心肌病引起肺部树芽征1例  

Tree-in-bud pattern on chest CT due to obstructive hypertrophic cardiomyopathy:a case report

作　　者：张龙富[1,2] 沈勤军 叶伶 朱蕾 ZHANG Long-fu;SHEN Qin-jun;YE Ling;ZHU Lei(Department of Pulmonary Medicine,Central Hospital of Xuhui District,Shanghai 200031,China;Department of Pulmonary Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]上海市徐汇区中心医院呼吸科,上海200031 [2]复旦大学附属中山医院呼吸科,上海200032

出　　处：《复旦学报（医学版）》2021年第4期565-568,共4页Fudan University Journal of Medical Sciences

摘　　要：患者咳嗽、胸闷、气促2月余,胸部CT表现为树芽征(tree-in-bud pattern,TIB)和磨玻璃斑片影,考虑感染引起的小气道病变可能,予以抗感染及对症治疗,患者症状无好转。入院后查氨基末端利钠肽前体(amino-terminal pro-brain natriuretic peptide,NT-proBNP)升高,结合肺部磨玻璃影,考虑心源性肺水肿可能,进一步完善心超,明确为梗阻性肥厚型心肌病,左室流出道压差明显升高;经针对性改善心功能治疗,患者症状好转,肺部病灶吸收。本文重点介绍TIB形成的病因、机制及鉴别诊断思路,提高临床医师对TIB的认识。The patient had cough,chest tightness and shortness of breath for more than 2 months,and chest CT showed tree-in-bud pattern(TIB)and ground glass patchy shadows.Considering the possibility of small airway disorders caused by infection,anti-infection and symptomatic treatment were applied,but the patient’s symptoms did not improve.After admission,amino-terminal pro-brain natriuretic peptide(NT-proBNP)was detected to be elevated.Combined with the pulmonary ground glass patchy shadows and the possibility of cardiogenic pulmonary edema,further improved cardiac ultrasound confirmed the diagnosis of obstructive hypertrophic cardiomyopathy.The pressure difference of left ventricular outflow tract was significantly increased.After treatment for improving cardiac function,the symptoms improved and the lung lesions were absorbed.This paper mainly introduces the etiology,formation mechanism and differential diagnosis of TIB,so as to improve the understanding of clinicians on TIB.

关 键 词：树芽征(TIB) 梗阻性肥厚型心肌病 慢性心功能不全 微血管 

分 类 号：R563[医药卫生—呼吸系统]