Zhu Qiaohong, Wu Xiaomei, Lin Hanfei, Zeng Qingsi, Li Xian, Shun Chongpeng
The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China. Email:
Zhonghua Jie He He Hu Xi Za Zhi. 2014 Sep;37(9):687-93.
To study the clinical features of bronchial-pulmonary arterial fistula, and to analyze its imaging features.
In continuous five months, 502 patients for pulmonary angiography were analyzed by pulmonary/aortic arterial two-phase scanning. The 128-slice MSCT (Siemens Definition AS 128) was used with the following parameters: the speed of 0.5 s/weeks, the collimator width of 64 × 0.6 mm, the pitch of 0.9, the tube voltage of 120 kV, the contrast agent of 300 mg/ml (1.2 ml/kg) , and the flow rate of 4.3 ml/s. Automatic trigger technology was used, while the threshold of the main pulmonary artery trunk was set to 80 HU. After 4 s delay, the pulmonary-arterial phase was scanned for 3-5 s. Then, the aortic-arterial phase was taken after 12 s. Finally, the clinical features and CTA two-phase images were analyzed by two radiologists, respectively. The diagnozied criteria of CTA images for bronchial-pulmonary arterial fistula were as following.In pulmonary/aortic arterial two-phase scanning, pulmonary artery or aortic artery could be displayed, respectively. The filling defect of fistula's pulmonary artery was observed in pulmonary arterial phase. However, the filling defect of fistula's pulmonary artery had significant filling in aortic arterial phase, with the similar density intensity of aortic artery.In addition, the thicken bronchial artery were observed in the fistula area.
In all 502 patients, 65 positive cases of the bronchial-pulmonary arterial fistula included 37 male cases and 28 female cases with ages from 45 to 83 years (69 ± 11). The clinical symptoms included hemoptysis (32%), anhelation (69%), hypoxia (66%), the raise of D2 dimer (70%), and pulmonary hypertension (64%). CTA two-phase images features: In the pulmonary-arterial phase, the intensity difference of pulmonary/aortic was [322 ± 122 (100-751)] HU. The local filling defect in the proximal pulmonary artery (12%) and the filling defect in the whole pulmonary artery (88%) were observed in 65 positive cases.In the aortic-arterial phase, the intensity difference of pulmonary/aortic was [251 ± 89 (85-428)] HU. The local enhancement in the proximal pulmonary artery (24%) and the enhancement in the whole pulmonary artery (76%) were observed in 58 positive cases. The visible thicken bronchial artery were observed in the fistula area of all cases.In 65 cases of bronchial-pulmonary arterial fistula, the fistula lesions contained 56 cases of lung lesions (including 35 cases of honeycomb lung, 16 cases of atelectasis, and 3 cases of chronic mass-like pneumonia) and 9 cases of vascular lesions (including 4 cases of chronic pulmonary artery embolism, 3 cases of congenital vascular malformation, 1 case of pulmonary arthritis, and 1 case of pulmonary artery aneurysm). 437 cases of non bronchial-pulmonary arterial fistula had 4 cases of of vascular lesions and 76 cases of lung lesions. There were significant statistic difference between the fistula and vascular lesions or lung lesions (the value of χ(2): 37.51 or 165.11, all values of P < 0.001).
The disease of bronchial-pulmonary arterial fistula usually occurred in the chronic pneumonia and the pulmonary vascular lesions. The CT pulmonary/aortic arterial two-phase scanning could detect the homodynamic changes to diagnosis this disease correctly. The pulmonary embolism need be differentiated.
研究支气管-肺动脉瘘的临床特征，并分析其影像学特点。
连续5个月对502例行肺血管造影的患者进行肺动脉/主动脉双期扫描分析。采用128层螺旋CT（西门子Definition AS 128），扫描参数如下：扫描速度0.5 s/周，准直器宽度64×0.6 mm，螺距0.9，管电压120 kV，对比剂浓度300 mg/ml（1.2 ml/kg），流率4.3 ml/s。采用自动触发技术，将主肺动脉干阈值设定为80 HU。延迟4 s后，对肺动脉期扫描3 - 5 s。然后，12 s后进行主动脉期扫描。最后，由两位放射科医师分别分析临床特征及CTA双期图像。支气管-肺动脉瘘CTA图像的诊断标准如下：在肺动脉/主动脉双期扫描中，可分别显示肺动脉或主动脉。在肺动脉期观察到瘘口处肺动脉充盈缺损。然而，在主动脉期瘘口处肺动脉充盈缺损有明显强化，密度强度与主动脉相似。此外，在瘘口区域观察到支气管动脉增粗。
502例患者中，支气管-肺动脉瘘阳性65例，其中男性37例，女性28例，年龄45～83岁（69±11岁）。临床症状包括咯血（32%）、呼吸困难（69%）、低氧血症（66%）、D-二聚体升高（70%）和肺动脉高压（64%）。CTA双期图像特征：肺动脉期，肺动脉/主动脉密度差值为[322±122（100 - 751）]HU。65例阳性病例中，观察到近端肺动脉局部充盈缺损（12%）和全肺动脉充盈缺损（88%）。主动脉期，肺动脉/主动脉密度差值为[251±89（85 - 428）]HU。58例阳性病例中，观察到近端肺动脉局部强化（24%）和全肺动脉强化（76%）。所有病例在瘘口区域均可见增粗的支气管动脉。65例支气管-肺动脉瘘患者中，瘘口病变包含56例肺部病变（包括35例蜂窝肺、16例肺不张和3例慢性肿块样肺炎）和9例血管病变（包括4例慢性肺动脉栓塞、3例先天性血管畸形、1例肺动脉炎和1例肺动脉瘤）。437例非支气管-肺动脉瘘患者有4例血管病变和76例肺部病变。瘘口与血管病变或肺部病变之间差异有统计学意义（χ²值：37.51或165.11，P值均<0.001）。
支气管-肺动脉瘘多见于慢性肺部疾病及肺血管病变。CT肺动脉/主动脉双期扫描可检测血流动力学变化以正确诊断该病，需与肺栓塞相鉴别。
