肺动脉肉瘤与肺栓塞临床及影像学特征对比  

Comparison of Clinical and Imaging Features Between Pulmonary Sarcoma and Pulmonary Embolism

作　　者：弓莉 杨瑞[1] 刘继伟[1] 高红[1] 于喜红[1] GONG Li;YANG Rui;LIU Jiwei;GAO Hong;YU Xihong(Department of Medical Imaging,Henan Chest Hospital,Zhengzhou University Chest Hospital,Zhengzhou 450000,China)

机构地区：[1]河南省胸科医院,郑州大学附属胸科医院医学影像科,河南郑州450000

出　　处：《河南医学研究》2023年第19期3585-3588,共4页Henan Medical Research

摘　　要：目的对比肺动脉肉瘤(PSA)与肺栓塞(PE)的临床及影像学特征。方法回顾性分析2015年3月至2023年3月河南省胸科医院收治且经病理学确诊的30例PSA患者和42例PE患者的临床及影像学资料,分析并比较PSA、PE临床特征及影像学特征。结果PSA、PE患者性别、年龄、胸痛、呼吸困难、咳嗽、晕厥、下肢水肿、脑钠肽(BNP)、C反应蛋白(CRP)差异无统计学意义(P>0.05)。相较于PSA患者,PE患者下肢深静脉血栓占比高,咯血、肺动脉高压占比低,D-二聚体、乳酸脱氨酶水平低,症状持续时间长(P<0.05)。主肺动脉、肺动脉结合部、左/右肺动脉主干受累,病变近端与肺动脉管壁角度<90°多见于PSA患者,右心室内钙化灶多见于PE患者(P<0.05)。PSA患者多为单发病灶,膨胀指数、最大横径、最大纵径大于PE患者(P<0.05)。PSA、PE患者膨出状轮廓、分叶状轮廓或瘤内血管差异有统计学意义(P<0.05)。PSA患者肺动脉期和主动脉期的增强CT值高于PE患者(P<0.05),而肺动脉期和主动脉期的平扫CT值差异无统计学意义(P>0.05)。结论肺动脉腔内充盈缺损且累及主肺动脉、肺动脉结合部或左/右肺动脉主干,累及部位呈膨胀性生长,临床有咯血、肺动脉高压等表现,高度提示PSA,临床存在下肢深静脉血栓、呼吸困难等表现则有助于临床诊断PE。Objective To compare the clinical and imaging features of pulmonary artery sarcoma(PSA)and pulmonary embolism(PE).Methods The clinical and imaging data of 30 patients with PSA and 42 patients with PE admitted to Henan Chest Hospital from March 2015 to March 2023 were retrospectively analyzed,and the clinical and imaging features of PSA and PE were analyzed and compared.Results There was no statistical difference in sex,age,chest pain,dyspnea,cough,syncope,edema of lower limbs,brain natriuretic peptide(BNP)and C-reactive protein(CRP)between PSA and PE patients(P>0.05).Compared with PSA patients,PE patients had higher proportion of deep venous thrombosis,lower proportion of hemoptysis and pulmonary hypertension,lower levels of D-dimer and lactate dehy-drogenase,and longer duration of symptoms(P<0.05).The main pulmonary artery,pulmonary artery junction and left/right pulmonary artery trunk were involved,and the angle between the proximal part of the lesion and the pulmonary artery wall was less than 90°,which was more common in PSA patients,and the calcification in the right ventricle was more common in PE patients(P<0.05).PSA patients were mostly single lesions,and the swelling index,maximum transverse diameter and maximum longitudinal diameter were larger than those of PE patients(P<0.05).There were statistical differences in bulging contour,lobulated contour or intratumoral blood vessels between PSA and PE patients(P<0.05).The enhanced CT values of PSA patients in pulmonary artery phase and aortic phase were higher than those of PE patients(P<0.05),but there was no statistical difference in plain CT values of pulmonary artery phase and aortic phase(P>0.05).Conclusion Pulmonary artery cavity filling defect involves the main pulmonary artery,pulmonary artery junction or left/right pulmonary artery trunk,and the involved site shows swelling growth.Clinical manifestations such as hemoptysis and pulmonary hypertension highly suggest PSA,and clinical manifestations such as deep venous thrombosis and dyspnea of lower l

关 键 词：肺动脉肉瘤 肺栓塞 临床特征 影像检查 鉴别诊断 

分 类 号：R563.5[医药卫生—呼吸系统]