以反晕征为主要CT表现的肺栓塞临床及影像特点分析  

Analysis on the clinical and imaging features of pulmonary embolism with reversed halo sign as the main CT manifestation

作　　者：黄盛晶 周昌盛 张霖 卢璐 张小宇 HUANG Shengjing;ZHOU Changsheng;ZHANG Lin;LU Lu;ZHANG Xiaoyu(Department of Pulmonary and Critical Care Medicine,the Affiliated Cangnan Hospital of Wenzhou Medical University,Wenzhou 325800,China;Department of Radiology,the Affiliated Cangnan Hospital of Wenzhou Medical University,Wenzhou 325800,China)

机构地区：[1]温州医科大学附属苍南医院呼吸与危重症医学科,浙江温州325800 [2]温州医科大学附属苍南医院放射科,浙江温州325800

出　　处：《温州医科大学学报》2024年第2期146-150,155,共6页Journal of Wenzhou Medical University

摘　　要：目的:分析以反晕征(RHS)为主要影像学表现的肺栓塞(PE)患者的临床及影像学特点,提高对这一影像征象的认识。方法:收集2016年1月至2023年4月温州医科大学附属苍南医院经CT肺动脉造影(CTPA)检查确诊的以RHS为主要CT表现的PE住院患者15例,对其临床资料和影像学特点进行回顾性分析和总结。结果:15例以RHS为主要CT表现的PE患者,临床症状主要表现为胸痛和呼吸困难,但仍有半数以上患者合并发热、咳嗽咳痰等症状,且出现白细胞、CRP升高,故有11例患者被误诊为肺炎并给予抗感染治疗。影像分析结果显示,15例患者共有16个RHS病灶,其中14例患者为单发病灶,1例患者可见2个RHS病灶。所有RHS病灶均位于下肺胸膜下,右下肺10个,左下肺6个;RHS病灶形态多为椭圆形(12/16),还可见楔形(2/16)及驼峰样改变(2/16),病灶长轴平行于胸膜;RHS中心为低密度的磨玻璃阴影,周围绕以边界尚光整的实性环,同时11例患者合并少量胸腔积液。经规范化抗凝治疗3个月以上,肺部RHS病灶均有吸收好转,部分残留少许纤维条索影,胸腔积液减少消失。结论:PE患者的RHS病灶多位于胸膜下,下肺多见,单发为主,病灶形态多为椭圆形,长轴平行于胸膜,同时常合并有少量胸腔积液。以RHS为主要CT表现的PE患者易被误诊为肺炎,对于具有上述影像特征的患者需警惕PE的可能。Objective:To analyze the clinical and imaging features of pulmonary embolism(PE)with reverse halo sign(RHS)as the main CT manifestation so as to better understand the value of this imaging sign in the early diagnosis of PE.Methods:A total of 15 PE inpatients confirmed by CT pulmonary angiography(CTPA)with RHS as the main CT manifestation were collected from the Affiliated Cangnan Hospital of Wenzhou Medical University from January 2016 to April 2023,whose imaging and clinical data were retrospectively analyzed and summarized.Results:Among the 15 PE patients with RHS as the main CT manifestation,the main clinical symptoms were chest pain and dyspnea,but more than half of the patients were complicated by fever,cough and sputum with elevated white blood cells and CRP,in which 11 patients were misdiagnosed as pneumonia and given anti-infection treatment.The results of imaging analysis showed that there were 16 RHS lesions in 15 patients,of which 14 patients had single lesions and 1 patient had 2 RHS lesions.All RHS lesions were located under the pleura of the lower lung,with 10 in the right lower lung and 6 in the left lower lung.RHS lesions were mostly oval(12/16),wedge-shaped(2/16)and hump-like changes(2/16),the long axis of the lesions parallel to the pleura.The RHS center showed low-density with ground-glass shadow surrounded by a solid ring with a polished border;meanwhile,11 patients had a small amount of pleural effusion.After more than 3 months of standardized anticoagulation treatment,all RHS lesions were absorbed,a few changed to linear scar,and pleural effusion disappeared.Conclusion:Most RHS lesions in PE patients are located under the pleura,especially common on the lower lung field,mainly single-lesion,oval in shape with the long axis parallel to the pleura and often at the same time combined with a small amount of pleural effusion.PE patients with RHS as the main CT manifestation are prone to the misdiagnosis of pneumonia.It should be vigilant for the possibility of PE in patients with the above imagin

关 键 词：肺栓塞 反晕征 肺梗死 体层摄影术 X线计算机 

分 类 号：R563.5[医药卫生—呼吸系统]