肺纤维化合并肺气肿综合征的CT影像学特征分析
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摘要
目的探讨肺纤维化合并肺气肿综合征(CPFE)的CT影像学特征及鉴别诊断,提高对该疾病的认识。方法回顾性分析33例CPFE患者的临床和CT资料,分析病变的形态特征及分布情况。结果 33例患者肺气肿分布全部以上肺为主(100%),肺纤维化则主要分布于下肺(85%)。肺气肿以间隔旁型肺气肿为主19例(58%)、小叶中心型肺气肿12例(36%),全小叶型肺气肿2例(6%),合并肺大疱9例(27%)。肺纤维化改变呈网状影22例(61%)、蜂窝影15例(46%)、牵拉性支气管扩张9例(27%)、磨玻璃样影18例(54%)、实变影5例(15%)、胸膜下线4例(12%)。结论 CPFE综合征CT影像学表现具有特征性,高分辨率检查在CPFE综合征诊断和病情评估中占有重要地位。
Objective To study the CT findings and differentical diagnosis of combined pulmonary fibrosis and emphysema,and to make a further under standing of the disease. Methods Thirty-three patients ' clinical and imaging data with CPFE were retrospectively analyzed, including the morphology and distribution of the leision. Results The results shows that the focus of 33 patients with emphysema mainly located in upper lung(100%). Pulmonary fibrosis was mainly located in lower lung(85%). In addition, 19 patients(58%) can be diagnosed as paraseptal emphysema,12 patients(36%) with centrilobular emphysema, 2 patients(6%) with panlobular emphysema, 9 patients(27%) with lung bullous emphysema(27%). As for the changes of pulmonary fibrosis, about 22 cases(61%) with subpleural reticulation, another 15 cases(46%) with honeycombing, tractional bronchiectasis in 9 cases, ground-glass opacity in 18 cases(54.5%), pulmonary consolidation in 5 cases(15.2%), pleural offline in 4 cases(12.1%). Conclusion CPFE has special changes in CT findings, high-Resolution CT plays an important role in the diagnosis and assessment of CPFE.
Objective To study the CT findings and differentical diagnosis of combined pulmonary fibrosis and emphysema,and to make a further under standing of the disease. Methods Thirty-three patients ' clinical and imaging data with CPFE were retrospectively analyzed, including the morphology and distribution of the leision. Results The results shows that the focus of 33 patients with emphysema mainly located in upper lung(100%). Pulmonary fibrosis was mainly located in lower lung(85%). In addition, 19 patients(58%) can be diagnosed as paraseptal emphysema,12 patients(36%) with centrilobular emphysema, 2 patients(6%) with panlobular emphysema, 9 patients(27%) with lung bullous emphysema(27%). As for the changes of pulmonary fibrosis, about 22 cases(61%) with subpleural reticulation, another 15 cases(46%) with honeycombing, tractional bronchiectasis in 9 cases, ground-glass opacity in 18 cases(54.5%), pulmonary consolidation in 5 cases(15.2%), pleural offline in 4 cases(12.1%). Conclusion CPFE has special changes in CT findings, high-Resolution CT plays an important role in the diagnosis and assessment of CPFE.
引文
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[13]Cottin V,Le Pavec J,Prévot G,et al.Pulmonary hypertension in patients with combined pulmonary fibrosis and emphysema syndrome[J].Eur Res J,2010,35(1):105-111.
[14]N Kwak,CM Park,J Lee,et al.Lung cancer risk among patients with combined pulmonary fibrosis and emphysema[J].Res Med,2014,108(3):524-530.
[15]Usui K,Tanai C,Tanaka Y,et al.The prevalence of pulmonary fibrosis combined with emphysema in patients with lung cancer[J].Respiralogy,2011,16(2):326-331.
[16]陈黎,蔡敏.特发性肺间质纤维化合并肺癌的研究进展[J].临床肺科杂志,2012,17(1):128-129.
[2]Wiggins J,Strickland B,Turner-Warwick M.Combined cryptogenic fibrosing alveolitis and emphysema:the value of high resolution computed tomography in assessment[J].Res Med,1990,84(5):365-369.
[3]Raghu G,Meyer KC.Silent gastro-oesophageal reflux and microaspiration in IPF:mounting evidence for antireflux therapy[J].Eur Res J,2012,39(2):242-245.
[4]Fell CD.Idiopathic pulmonary fibrosis:phenotypes and comorbidities[J].Clin Chest Med,2012,33(1):51-57.
[5]Cottin V,Nunes H,Brillet PY,et al.Combined pulmonary fibrosis and emphysema:a distinct under recognised entity[J].Eur Res J,2005,26(4):586-593.
[6]Jankowich MD,Rounds SI.Combined pulmonary fibrosis and emphysema syndrome:a review[J].Chest,2012,141(1):222-231.
[7]Cottin V,Prevot G,Mal H.Pulmonary hypertension in patient with combined pulmonary fibrosis and emphysema syndrome[J].Eur Res J,2010,35(1):105-111.
[8]王利玲,吴强鹏,程黎,等.肺纤维化合并肺气肿综合征的病理特征及影响因素分析[J].河北医药,2016,38(21):3299-3301.
[9]Matsuoka S,Yamashiro T,Matsushita S,et al.Quantitative CTevaluation in patients with combined pulmonary fibrosis and emphysema:correlation with pulmonary function[J].Academic radiol,2015,22(5):626-631.
[10]王振光,路晓东,孔令琦,等.长期无症状吸烟者肺小气道损害的HRCT表现[J].中国医学影像技术,2002,18(1):15-17.
[11]Jankowich MD,Polsky M,Klein M,et al.Heterogeneity in cornbined pulmonary fibrosis and emphysema[J].Respiration,2008,75(4):411-417.
[12]V Cottin,H Nunes,PY Brillet,et al.Combined pulmonary fibrosis and emphysema:a distinct underrecognised entity[J].Eur Res J,2005,26(4):586-593.
[13]Cottin V,Le Pavec J,Prévot G,et al.Pulmonary hypertension in patients with combined pulmonary fibrosis and emphysema syndrome[J].Eur Res J,2010,35(1):105-111.
[14]N Kwak,CM Park,J Lee,et al.Lung cancer risk among patients with combined pulmonary fibrosis and emphysema[J].Res Med,2014,108(3):524-530.
[15]Usui K,Tanai C,Tanaka Y,et al.The prevalence of pulmonary fibrosis combined with emphysema in patients with lung cancer[J].Respiralogy,2011,16(2):326-331.
[16]陈黎,蔡敏.特发性肺间质纤维化合并肺癌的研究进展[J].临床肺科杂志,2012,17(1):128-129.