螺旋CT对肺撕裂伤的诊断及动态观察应用价值
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摘要
目的:探讨螺旋CT在肺撕裂伤的诊断及动态观察中的应用价值。方法:回顾性分析20例肺撕裂伤的CT表现。结果:20例患者共发现45个病灶,右肺25个,左肺20个。CT表现为肺气囊9个、肺气液囊12个、胸膜下气泡影15个、肺血肿7个及楔形含气裂隙2个。肺撕裂伤周围均合并不同程度的肺挫伤。45个病灶中,26个病灶位于肺表面或胸膜下,5个病灶位于肺深部,14个病灶位于脊柱旁。20例患者均伴有肋骨骨折,8例患者合并血气胸。CT动态观察,发现7个肺气囊腔内见液体进入,形成肺气液囊;胸膜下气泡影6例形成血气胸,5例出现肺血肿伴胸腔积液;1~2月肺气囊、肺气液囊及肺血肿吸收和缩小。结论:肺气囊、肺气液囊及胸膜下气泡影是肺撕裂伤特征性CT表现,肺楔形含气裂隙是该病特有的CT征象。CT检查是早期发现、诊断和动态观察肺撕裂伤最有效的影像检查方法。
Objective: To investigate the application value of spiral CT in the diagnosis and dynamic observation of pulmonary laceration. Methods: CT results of twenty patients with pulmorary laceration were retrospectively analyzed. Results: A total of 45 lesions were found in the 20 patients, with 25 on the right side and 20 on the left side. CT manifestations were pneumatocele(n = 9), pulmonary liquid-air cavity(n = 12), sub-pleural gas-bubble shadow(n= 15), intrapulmonary hematoma(n = 7) and wedge shaped gas fissures(n = 2). Various degrees of lung contusion around the pulmonary laceration could be observed in all patients. The locations of the 45 lesions of laceration included lung surface or sub-pleural region(n = 26), deep site of lung(n = 5) and paravertebral area(n = 14). Rib fracture was detected in all patients and hemopneumothorax was found in 8 patients. The results of CT dynamic observation are as follows: liquid was seen and pulmonary liquid-air cavities were formed in 7 lung cavities, 6 sub-pleural gas-bubble shadow formed into hemopneumothorax, while 5 patients were diagnosed as pulmonary hematoma with pleural effusion. Besides, pneumatocele, pulmonary liquid-air cavity and absorption and shrinkage of pulmonary hematoma were found in one or two months. Conclusion: The characteristic manifestations of pulmonary laceration are pneumatocele, pulmonary liquid-air cavity and sub-pleural gas-bubble shadow, while the wedge shaped gas fissures is a specific sign of the disease. Spiral CT examination plays the most effective role in early detection and diagnosis and dynamic observation of the pulmonary laceration.
Objective: To investigate the application value of spiral CT in the diagnosis and dynamic observation of pulmonary laceration. Methods: CT results of twenty patients with pulmorary laceration were retrospectively analyzed. Results: A total of 45 lesions were found in the 20 patients, with 25 on the right side and 20 on the left side. CT manifestations were pneumatocele(n = 9), pulmonary liquid-air cavity(n = 12), sub-pleural gas-bubble shadow(n= 15), intrapulmonary hematoma(n = 7) and wedge shaped gas fissures(n = 2). Various degrees of lung contusion around the pulmonary laceration could be observed in all patients. The locations of the 45 lesions of laceration included lung surface or sub-pleural region(n = 26), deep site of lung(n = 5) and paravertebral area(n = 14). Rib fracture was detected in all patients and hemopneumothorax was found in 8 patients. The results of CT dynamic observation are as follows: liquid was seen and pulmonary liquid-air cavities were formed in 7 lung cavities, 6 sub-pleural gas-bubble shadow formed into hemopneumothorax, while 5 patients were diagnosed as pulmonary hematoma with pleural effusion. Besides, pneumatocele, pulmonary liquid-air cavity and absorption and shrinkage of pulmonary hematoma were found in one or two months. Conclusion: The characteristic manifestations of pulmonary laceration are pneumatocele, pulmonary liquid-air cavity and sub-pleural gas-bubble shadow, while the wedge shaped gas fissures is a specific sign of the disease. Spiral CT examination plays the most effective role in early detection and diagnosis and dynamic observation of the pulmonary laceration.
引文
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[8]于武江.闭合性肺实质损伤的影像学表现[J].中国中西医结合影像学杂志,2014,12(2):172-174.Yu WJ.Imaging findings of closed pulmonary parenchyma injury[J].Chinese Imaging Journal of Integrated Traditional and Western Medicine,2014,12(2):172-174.(in Chinese).
[9]殷亮,周永生,徐茂盛,等.创伤性肺假性囊肿CT影像转归的分析[J].实用放射学杂志,2013,29(12):1945-1947.Yin L,Zhou YS,Xu MS,et al.Analysis of CT images of outcome of traumatic pulmonary pseudocyst[J].Journal of Practical Radiology,2013,29(12):1945-1947.(in Chinese).
[10]王之平,许永明.肺撕裂伤的螺旋CT诊断[J].实用放射学杂志,2011,27(4):522-525.Wang ZP,Xu YM.Spiral CT diagnosis of pulmonary laceration[J].Journal of PracticalRadiology,2011,27(4):522-525.(in Chinese).
[11]黄趯渠,李均洪,梁振华,等.肺撕裂伤的CT表现和动态观察[J].CT理论与应用研究,2013,22(2):303-308.Huang TQ,Li JH,Liang ZH,et al.CT manifestation and dynamic observation of pulmonary laceration[J].CT Theory and Application,2013,22(2):303-308.(in Chinese).
[12]黄升刚,曹存友,牟高建,等.外伤性肺血肿的CT动态观察[J].临床放射学杂志,2012,31(1):47-50.Huang SG,Cao QY,Mou GJ,et al.CT dynamic analysis of truaumatic pulmonary laceration[J].Journal of Clinical Radiology,2012,31(1):47-50.(in Chinese).
[2]项荣伟,杨运俊,王土地,等.肺撕裂伤的多层螺旋CT表现[J].医学影像学杂志,2013,23(2):210-212.Xiang RW,Yang YJ,Wang TD,et al.Multislice spiral CT findings of pulmonary laceration[J].Journal of Medical Imaging,2013,23(2):210-212.(in Chinese).
[3]刘成磊,孙志先,刘婕,等.肺撕裂伤的CT诊断及分型[J].临床放射学杂志,2015,34(5):725-728.Liu CL,Sun ZX,Liu J,et al.CT diagnosis and classification of pulmonary laceration[J].Journal of Clinical Radiology,2015,34(5):725-728.(in Chinese).
[4]彭梦明,唐肇善,钱新初,等.肺撕裂伤的CT分型及临床意义[J].中华创伤杂志,2009,25(6):493-495.Peng MM,Tang ZS,Qian XC,et al.CT classification of lacerating lung injury and its clinical significance[J].Chinese Journal Trauma,2009,25(6):493-495.(in Chinese).
[5]胡晓峰,吕维富,潘志立,等.肺撕裂伤的CT诊断[J].放射学实践,2010,25(5):509-511.Hu XF,Lv WF,Pan ZL,et al.CT diagnosis of pulmonary laceration[J].Radiological Practice,2010,25(5):509-511.(in Chinese).
[6]侯民羊,苟杰.急性肺撕裂伤的CT表现及其诊断价值[J].现代医学影像学,2010,19(2):82-84.Hou MY,Gou J.CT manifestations and diagnostic value of acute pulmonary laceration[J].Modern Medical Imaging,2010,19(2):82-84.(in Chinese).
[7]唐军,李明,张毅军.多排螺旋CT在肺挫伤和肺撕裂伤诊断中的应用价值[J].创伤外科杂志,2014,16(5):477-478.Tang J,Li M,Zhang YJ.The application value of multislice spiral CT in the diagnosis of pulmonary contusion and lung laceration[J].Journal of Trauma Surgery,2014,16(5):477-478.(in Chinese).
[8]于武江.闭合性肺实质损伤的影像学表现[J].中国中西医结合影像学杂志,2014,12(2):172-174.Yu WJ.Imaging findings of closed pulmonary parenchyma injury[J].Chinese Imaging Journal of Integrated Traditional and Western Medicine,2014,12(2):172-174.(in Chinese).
[9]殷亮,周永生,徐茂盛,等.创伤性肺假性囊肿CT影像转归的分析[J].实用放射学杂志,2013,29(12):1945-1947.Yin L,Zhou YS,Xu MS,et al.Analysis of CT images of outcome of traumatic pulmonary pseudocyst[J].Journal of Practical Radiology,2013,29(12):1945-1947.(in Chinese).
[10]王之平,许永明.肺撕裂伤的螺旋CT诊断[J].实用放射学杂志,2011,27(4):522-525.Wang ZP,Xu YM.Spiral CT diagnosis of pulmonary laceration[J].Journal of PracticalRadiology,2011,27(4):522-525.(in Chinese).
[11]黄趯渠,李均洪,梁振华,等.肺撕裂伤的CT表现和动态观察[J].CT理论与应用研究,2013,22(2):303-308.Huang TQ,Li JH,Liang ZH,et al.CT manifestation and dynamic observation of pulmonary laceration[J].CT Theory and Application,2013,22(2):303-308.(in Chinese).
[12]黄升刚,曹存友,牟高建,等.外伤性肺血肿的CT动态观察[J].临床放射学杂志,2012,31(1):47-50.Huang SG,Cao QY,Mou GJ,et al.CT dynamic analysis of truaumatic pulmonary laceration[J].Journal of Clinical Radiology,2012,31(1):47-50.(in Chinese).