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目的:找出高原肺鼠疫和高原肺水肿二者X线胸片鉴别要点。方法:收集2009年青海省海南州成功救治4例确诊肺鼠疫患者胸部X线片与高原肺水肿X线胸片进行综合分析比对。结果:①早期肺鼠疫X线主要表现为两肺中下野斑片状模糊增密影,密度均匀,两肺门影增浓,心脏外形无扩大,双膈面光滑肋膈角稍钝;②激进期主要表现为出性病灶,密度进行性增加,范围扩大,密度不均匀,其内可见边缘模糊结节影,多以两肺中下野为主,结节影伴有轻度分层征象,密度较炎性渗出性病灶略高,同时出现少-中量胸腔积液。结论:高原肺鼠疫与高原肺水肿X线鉴别要点:①高原肺水肿肺门改变出现较早,两肺野透过度普遍降低。高原肺水肿病灶早期以肺间质异常为主[6]。典型进展期两肺门为中心呈对称性云翼样模糊增密影。也可以不对称只表现一侧肺门扩大、模糊;②高原地区肺鼠疫肺门改变多出现在毒血症期,多不对称。透过度降低多出现在24小时以后的毒血症期,密度不均匀。进展期改变多以肺实质异常为主。病灶形态表现为纤细网纹状改变或小斑片影、小结节样影,以右肺中下叶多见。高原肺鼠疫病灶多比较局限,以片状实变影为主,密度不均匀,其内可见边缘模糊结节影,较致密,伴有轻度分层征象,两肺中下野均可见。多迅速合并中量胸腔积液。
OBJECTIVE: To identify the main points of differential diagnosis of both plateau pneumonic plague and high altitude pulmonary edema by X-ray. Methods: A total of 4 cases of pneumonic plague diagnosed in Hainan Province in 2009 were collected for comprehensive analysis and comparison of chest X-ray and high altitude pulmonary edema. Results: (1) X-ray of early stage pneumonic plague mainly manifested as patchy fuzzy densification of middle and lower lungs in both lungs with uniform density, Period of the main performance of the lesion, the density increased sexually, the scope of the expansion, the density is uneven, which can be seen fuzzy edge nodules, mostly in the middle and lower back two lung-based, nodular shadow accompanied by mild stratification signs, density Slightly higher than the inflammatory exudative lesions, while there is less - in the amount of pleural effusion. Conclusion: X-ray diagnosis of pneumonic plague in the plateau and pulmonary edema of the highland are as follows: ① Hilar pulmonary edema occurred earlier in the plateau, and field penetrance of both lungs generally decreased. High altitude pulmonary edema early lung interstitial abnormalities [6]. Typical two hilar doors are symmetrical center of the cloud-like blurring. Asymmetry can only show the side of the hilar enlargement, vague; ② pneumoconiosis in the plateau region Hp changes occur in the toxemia phase, more asymmetric. Permeability decreased more in 24 hours after the onset of toxemia, uneven density. Progressive changes in the main lung abnormalities. Morphological manifestations of the lesion as fine reticular changes or small patchy shadow, small nodules like shadow, more common in the lower lobe of the right lung. Plateau pneumonic plague lesions were more limited, with sheet-like consolidation of the main, uneven density, which can be seen fuzzy edge nodules, more dense, with mild stratification signs, both lungs can be seen in the middle and lower back. More rapid integration of pleural effusion.