Woolley K, Stark P
Department of Radiology, VA Palo Alto Health Care System, CA, USA.
Radiographics. 1999 Jul-Aug;19(4):965-72. doi: 10.1148/radiographics.19.4.g99jl10965.
Pulmonary parenchymal manifestations of mitral valve disease are the result of either pulmonary venous hypertension in mitral stenosis or abnormal regurgitant flow into pulmonary veins in mitral insufficiency. Typical radiographic findings in mitral stenosis include pulmonary vascular cephalization; interstitial, perivascular, and occasionally alveolar pulmonary edema; diffuse alveolar hemorrhage; hemosiderosis; and pulmonary ossification. Signs of interstitial pulmonary edema are frequently visible and include septal lines. Radiographic findings in diffuse alveolar hemorrhage consist of diffuse, confluent acinar or ground-glass areas of increased opacity, often sparing the peripheral parenchyma and creating the so-called window frame effect. Hemosiderosis is characterized by small, ill-defined nodules or by coarse reticular areas of increased opacity with a bias for the middle and lower lung regions. Ossification manifests as densely calcified, 1-5-mm nodules, mainly in the middle and lower lungs, with a tendency for confluence and the occasional presence of trabeculae. Imaging findings in mitral regurgitation depend on the acuteness of the disease. The most common parenchymal manifestations of acute mitral regurgitation are symmetric alveolar and interstitial pulmonary edema with indistinct, engorged pulmonary vessels and cephalized blood flow. Familiarity with these manifestations can expedite diagnosis, particularly in rare cases of unsuspected mitral valve disease.
二尖瓣疾病的肺实质表现是二尖瓣狭窄时肺静脉高压或二尖瓣关闭不全时异常反流进入肺静脉的结果。二尖瓣狭窄典型的影像学表现包括肺血管头化；间质、血管周围，偶尔还有肺泡性肺水肿；弥漫性肺泡出血；含铁血黄素沉着症；以及肺骨化。间质性肺水肿的征象常常可见，包括间隔线。弥漫性肺泡出血的影像学表现为弥漫性、融合性腺泡或磨玻璃样密度增高区，通常不累及周边实质，形成所谓的“窗框征”。含铁血黄素沉着症的特征是小的、边界不清的结节或密度增高的粗大网状区域，以中、下肺区为主。骨化表现为密集钙化的1 - 5毫米结节，主要位于中、下肺，有融合倾向，偶尔可见小梁。二尖瓣反流的影像学表现取决于疾病的急性程度。急性二尖瓣反流最常见的实质表现是对称性肺泡和间质性肺水肿，肺血管模糊、充血，血流头化。熟悉这些表现有助于加快诊断，特别是在罕见的未被怀疑的二尖瓣疾病病例中。
