多层螺旋CT诊断地震伤员肺动脉栓塞的初步探讨
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摘要
目的初步探讨多层螺旋CT扫描在诊断地震伤员肺动脉栓塞(PE)中的价值。方法对23名地震伤员行胸部多层螺旋CT平扫,分析其放射学征象,并在不结合和结合其他临床资料的情况下对有无PE进行前瞻性预测,评价两种情况下诊断PE的灵敏度;对可疑PE的患者加行肺动脉CT造影扫描,明确有无PE。结果23名地震伤员中,有4名(17%)最后诊断为PE。胸部平扫的征象中,垂直于胸膜面的条带状影见于3例PE患者(75%)及3例无PE的患者(15%)(P值=0.04),紧贴胸膜的肺野外带实变见于3例PE患者(75%)及4例无PE的患者(21%)(P值=0.067),胸腔积液见于3例PE患者(75%)及3例无PE的患者(15%)(P值=0.04),而同时出现上述征象见于3例PE的患者(75%)及1例无PE的患者(5%)(P值=0.009)。在未结合其他临床资料的情况下,CT平扫诊断肺动脉栓塞的灵敏度仅为25%,反之可达75%;肺动脉CT造影显示4例患者共17支肺动脉发生栓塞,除1支为肺叶动脉外,其余16支均发生于肺段动脉,表现为完全性充盈缺损,部分性充盈缺损以及"轨道"征。结论地震创伤容易发生肺动脉栓塞,认识肺动脉栓塞的一些辅助征象并密切结合其他临床资料有助于诊断PE,对可疑病例应及时行肺动脉CT造影明确诊断。
Objective To preliminarily evaluate the value of multislice spiral CT scanning in diagnosing pulmonary embolism(PE) of earthquake victims.Methods Twenty-three earthquake victims underwent thoracic multislice spiral CT scan,all ancillary signs suggesting PE were prospectively reviewed.The sensitivity of predicting PE with informed clinical data or without were compared.Additional pulmonary artery CT angiography was performed in the victims with suspected pulmonary embolism.Results Among 23 cases,4(17%) victims were diagnosed as PE.The ancillary signs induded linear bands which were seen in 3 victims with PE(75%) and 3 victims without PE(15%)(P =0.04),consolidation beneath pleura which were seen in 3 victims with PE(75%) and 4 victims without PE(26%)(P =0.067),pleural effusion which were seen in 3 victims with PE(75%) and 3 victims without PE(15%)(P =0.04).All ancillary signs above mentioned were showed simultaneously in 3 victims with PE(75%) and 1victim without PE(5%)(P =0.009).The sensitivity of CT plain scans for predicting PE in earthquake victims with informed clinical data and without those was 75% and 25%,respectively.Seventeen branches of all pulmonary artery branches in 4 victims with PE were found to be complete filling-defect,partial filling-defeet and "railway track" sign,one of 17 branches located at lobar artery while remains located at segmental artery.Conclusion Earthquake trauma easy induce secondary PE.Recognizing some ancillary signs acquired from CT plain scans and combining with clinical data would help us predicting PE.For earthquake victims with clinically suspected PE,pulmonary artery CT angiography should be performed as early as possible.
Objective To preliminarily evaluate the value of multislice spiral CT scanning in diagnosing pulmonary embolism(PE) of earthquake victims.Methods Twenty-three earthquake victims underwent thoracic multislice spiral CT scan,all ancillary signs suggesting PE were prospectively reviewed.The sensitivity of predicting PE with informed clinical data or without were compared.Additional pulmonary artery CT angiography was performed in the victims with suspected pulmonary embolism.Results Among 23 cases,4(17%) victims were diagnosed as PE.The ancillary signs induded linear bands which were seen in 3 victims with PE(75%) and 3 victims without PE(15%)(P =0.04),consolidation beneath pleura which were seen in 3 victims with PE(75%) and 4 victims without PE(26%)(P =0.067),pleural effusion which were seen in 3 victims with PE(75%) and 3 victims without PE(15%)(P =0.04).All ancillary signs above mentioned were showed simultaneously in 3 victims with PE(75%) and 1victim without PE(5%)(P =0.009).The sensitivity of CT plain scans for predicting PE in earthquake victims with informed clinical data and without those was 75% and 25%,respectively.Seventeen branches of all pulmonary artery branches in 4 victims with PE were found to be complete filling-defect,partial filling-defeet and "railway track" sign,one of 17 branches located at lobar artery while remains located at segmental artery.Conclusion Earthquake trauma easy induce secondary PE.Recognizing some ancillary signs acquired from CT plain scans and combining with clinical data would help us predicting PE.For earthquake victims with clinically suspected PE,pulmonary artery CT angiography should be performed as early as possible.
引文
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[14]Schwickert HC,Schweden F,Schild HH,et al.Pulmonary arteries and lung parenchyma in chronic pulmonary embolism:preoperative and postoperative CT findings[J].Radiology,1994,191(2):351-357.
[15]Worsley DF,Alavi A,Aronchick JM,et al.Chest radiographic find-ings in patients with acute pulmonary embolism:observations from the PIOPED study[J].Radiology,1993,189(1):133-136.
[16]Wittram C,Maher MM,Yoo AJ,et al.CT Angiography of pulmonary embolism:diagnostic criteria and causes of misdiagnosis[J].Radio-graphics,2004,24(5):1219-1238.
[17]Anderson JT,Jenq T,Bain M,et al.Diagnosis of posttraumatic pul-monary embolism:is chest computed tomographic angiography ac-ceptable-[J].J Trauma,2003,54(3):472-477.
[2]Duman H,Kulahci Y,Sengezer M.Fasciotomy in crush injury re-sulting from prolonged pressure in an earthquake in Turkey[J].E-merg Med J,2003,20(1):251-252.
[3]Ukai T.New type of preventable death[J].Prehosp Disaster Med,2005,20(3):202.
[4]Remy-Jardin M,Remy J,Artaud D,et al.Peripheral pulmonary ar-teries:optimization of the spiral CT acquisition protocol[J].Radiolo-gy,1997,204(1):157-163.
[5]Remy-Jardin M,Tillie-Leblond I,Szapiro D,et al.CT angiography of pulmonary embolism in patients with underlying respiratory dis-ease:impact of multislice CT on image quality and negative predic-tive value[J].Eur Radiol,2002,12(10):1971-1978.
[6]Remy-Jardin M,Remy J,Wattinne L,et al.Central pulmonary thromboembolism:diagnosis with spiral volumetric CT with the sin-gle-breath-hold technique-comparison with pulmonary angiogra-phy[J].Radiology,1992,185(2):381-387.
[7]新华网.四川汶川地震抗震救灾进展情况.[online:21Aug2008;accessed:22Aug2008].Available from:http://news.xinhuanet.com/newscenter/2008-08/21/content_9578190.htm
[8]Watanabe H.Impact of earthquakes on risk for pulmonary embolism[J].Int J Cardiol(2007),doi:10.1016/j.ijcard.2007.06.039
[9]Inoue K.Venous thromboembolism in earthquake victims[J].Disas-ter Manag Response,2006,4(1):25-27.
[10]Kario K,McEwen BS,Pickering TG.Disasters and the heart:a re-view of the effects of earthquake-induced stress on cardiovascular disease[J].Hypertens Res,2003,26(2):355-367.
[11]Rogers FB.Venous thromboembolism in trauma patients:A review[J].Surgery,2001,130(1):1-12.
[12]Coche EE,Müller NL,Kim KI,et al.Acute pulmonary embolism:ancillary findings at spiral CT[J].Radiology,1998,207(3):753-758.
[13]Shah AA,Davis SD,Gamsu G,et al.Parenchymal and pleural find-ings in patients with and without acute pulmonary embolism detect-ed at spiral CT[J].Radiology,1999,211(1):147-153.
[14]Schwickert HC,Schweden F,Schild HH,et al.Pulmonary arteries and lung parenchyma in chronic pulmonary embolism:preoperative and postoperative CT findings[J].Radiology,1994,191(2):351-357.
[15]Worsley DF,Alavi A,Aronchick JM,et al.Chest radiographic find-ings in patients with acute pulmonary embolism:observations from the PIOPED study[J].Radiology,1993,189(1):133-136.
[16]Wittram C,Maher MM,Yoo AJ,et al.CT Angiography of pulmonary embolism:diagnostic criteria and causes of misdiagnosis[J].Radio-graphics,2004,24(5):1219-1238.
[17]Anderson JT,Jenq T,Bain M,et al.Diagnosis of posttraumatic pul-monary embolism:is chest computed tomographic angiography ac-ceptable-[J].J Trauma,2003,54(3):472-477.
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