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目的:探讨人感染H7N9禽流感病毒性重症肺炎的影像学检查方法及胸部X线、CT影像表现及动态变化特点。方法:对17例(男9例,女8例)确诊人感染H7N9禽流感病毒性重症肺炎患者行胸部X线摄片和薄层CT扫描检查,由2名影像学专家对其影像表现及动态变化进行评价分析。结果:①早期病变位于一侧肺下叶15例,位于上肺叶者2例。进展期病变累及双侧肺16例(16/17,94.1%),累及一侧肺叶1例(1/17,5.9%),病变累及4~6个肺叶共16例(94.1%)。②早期和进展期影像学表现见磨玻璃样影和/或肺实变影17例(17/17,100%);13例患者出现胸膜腔积液(13/17,76.5%)。③恢复期主要表现为多发小斑片影(14例)、片状磨玻璃影(9例)、条索状影(16例)及肺气囊(3例)。出院前胸部CT检查以网格状及胸膜下线影(6例)间隔旁肺气肿、瘢痕型肺气肿及纵隔旁胸膜下肺大疱等(4例)为主。2例合并有鲍曼不动杆菌感染,其中1例还合并双侧股骨头缺血坏死。有15例符合最早出现的病灶晚吸收,较晚出现的病灶最早吸收的特点。结论:人感染H7N9禽流感病毒性重症肺炎患者具有明显磨玻璃样影及肺实变表现,病灶以两下叶及背部为著,变化快且广泛,病灶吸收缓慢,恢复期见肺纤维化等特点。影像学的动态观察对指导临床诊断、治疗以及判断预后有一定价值。
OBJECTIVE: To investigate the imaging methods and chest X-ray and CT imaging features of human infected H7N9 avian influenza virus severe pneumonia and their dynamic changes. Methods: Seven cases (9 males and 8 females) were diagnosed as H7N9 avian influenza virus severe pneumonia patients underwent chest X-ray and thin layer CT scan examination by two imaging experts on the imaging performance and dynamic Changes in the evaluation analysis. Results: ① The early lesion was located on the side of the lower lobe in 15 cases and in the upper lobe in 2 cases. There were 16 cases (16/17, 94.1%) with bilateral lung involvement in the advanced stage, 1 case (1 / 17,5.9%) involving the one side of the lung and 16 cases (94.1%) with 4 to 6 lobes. ② Early and advanced imaging findings were seen in 17 cases (17/17, 100%) with ground-glass opacification and / or consolidation of the lung; 13 cases had pleural effusion (13/17, 76.5%). (3) The convalescence mainly showed multiple small patches (14 cases), lamellar ground glass (9 cases), cords (16 cases) and lung balloon (3 cases). Thoracic CT examination before discharge to the grid and subpleural line shadow (6 cases) interval emphysema, scar emphysema and mediastinal subpleural bulla (4 cases) based. Accompanied by Acinetobacter baumannii infection in 2 cases, 1 of them also had bilateral avascular necrosis of the femoral head. There are 15 cases of late absorption of the earliest appearance, the earliest appearance of the lesion absorption characteristics. Conclusion: The H7N9 avian influenza virus severe pneumonia patients showed obvious ground-glass opacification and pulmonary consolidation. The lesions were located on the two lower leaves and the back, changed rapidly and extensively, the lesions were slowly absorbed, and pulmonary fibrosis was found during the recovery period Features. The dynamic observation of imaging studies to guide the clinical diagnosis, treatment and prognosis of a certain value.