以发热为首诊的鹦鹉热肺炎的动态影像变化分析  

Dynamic Imaging Analysis of Psittacosis Pneumonia with Fever as the Initial Diagnosis

作　　者：刘沁茹 谭长连[1] 蔡赛男[1] 沈琴[1] 王敏[1] 袁佳莹 刘玉靖 唐玉清 李旭 廖海燕 毛珍妮 LIU Qinru;TAN Changlian;CAI Sainan(Department of Radiology,the Second Xiangya Hospital,Central South University,Changsha,Hunan Province 410011,P.R.China)

机构地区：[1]中南大学湘雅二医院放射科,长沙410011 [2]长沙市第三医院,410035 [3]湖南省医学影像临床医学研究中心

出　　处：《临床放射学杂志》2024年第11期1891-1896,共6页Journal of Clinical Radiology

基　　金：湖南省自然科学基金项目(编号:2022JJ30818);长沙市自然科学基金项目(编号:kq2202416);湖南省医学影像临床医学研究中心(编号:2020SK4001)。

摘　　要：目的总结分析以发热为首诊的鹦鹉热肺炎患者的胸部HRCT影像特征及动态变化。方法回顾性分析2020年1月至2022年3月收治的15例以发热主诉并采用宏基因组二代测序技术确诊的鹦鹉热肺炎患者的HRCT首诊影像表现及动态影像变化。结果初诊CT单肺叶发病14例,多肺叶(且为双肺)发病1例。影像学表现主要为肺实变伴充气支气管征,部分患者表现为实变伴磨玻璃阴影(GGO)或胸腔积液。第二次CT检查13例单肺叶受累患者病灶均明显吸收好转,表现为原病灶范围缩小、数量减少或密度减低,伴胸腔积液者积液减少。1例首诊CT为单肺叶受累伴单侧胸腔积液患者,实变及磨玻璃影范围增多并且累及双侧多肺叶,胸腔积液增多(且为双侧)。1例原双肺多肺叶受累患者,实变、磨玻璃影范围及数量较前增多、双侧胸腔积液亦较前增多。第三次CT显示13例第二次CT病灶减少的鹦鹉热患者病灶进一步吸收:其中12例病灶完全吸收;1例病灶明显吸收,但仍有残留未吸收病灶,表现为纤维条索影。1例第二次CT进展为双肺叶受累者显示病灶较前明显吸收,表现为实变和磨玻璃影范围缩小及减少,双侧胸腔积液较前减少。另1例多肺叶、双侧肺受累患者,实变、磨玻璃影范围及数量进一步增多、双侧胸腔积液较前增多,且出现右肺尖段肺动脉分支栓塞。结论鹦鹉热肺炎的影像学表现有一定特征,但特异性较差,结合临床病史有助于诊断。虽然仅靠胸部HRCT诊断鹦鹉热比较困难,但是HRCT有助于评估鹦鹉热肺炎的严重程度及治疗转归。Objective Analyze the chest HRCT imaging characteristics and dynamic changes of patients with psittacosis pneumonia,whose initial diagnosis is fever.Methods From January 2020 to March 2022,the HRCT findings and dynamic image changes of patients with Psittacosis pneumonia admitted to the Second Xiangya Hospital affiliated to Central South University(12 cases)and the Third Hospital of Changsha(3 cases)with fever as the main complaint and confirmed by the second generation sequencing technology of metagenome were retrospectively analyzed.Results 14 cases of single lobar lung disease and 1 case of multi lobar(and double lobed)disease were initially diagnosed on CT.The imaging findings were lung consolidation with air bronchial signs,and some patients showed consolidation with GGO or pleural effusion.The second CT examination showed that 13 patients with single lobe involvement had obvious absorption and improvement of the focus,which showed that the original focus area was reduced,the number or density was reduced,and the amount of pleural effusion was reduced.One case had a single lobe involvement with unilateral pleural effusion on CT at the first diagnosis,which now showed consolidation,increased GGO range and bilateral multiple lobes involved,and increased pleural effusion(both sides).One patient with multiple lobar involvement of the original lungs became reality,the range and number of GGOs increased,and bilateral pleural effusion also increased.The third CT showed that 13 cases of Psittacosis patients with reduced focus on the second CT had further absorption of the focus:12 cases had complete absorption of the focus,and 1 case had obvious absorption of the focus,but there was still residual unabsorbed focus,which was manifested as fiber streak shadow.One case(6.67%)with double lobe involvement on the second CT scan showed that the lesion was obviously absorbed,showing consolidation,narrowing and decreasing of GGO range,and bilateral pleural effusion.The other one(6.67%)had multiple lobes,bilateral pulmonary i

关 键 词：肺炎 鹦鹉热 发热 HRCT 

分 类 号：R518.1[医药卫生—内科学] R816.4[医药卫生—临床医学]