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[基于计算机断层扫描特征的高原肺水肿与新型冠状病毒肺炎的鉴别诊断]

[Differential diagnosis of high altitude pulmonary edema and COVID-19 with computed tomography feature].

作者信息

Li Wenzhe, Li Kai, Zhang Nan, Chen Gaofeng, Li Wenjun, Tang Jun, Yuan Fang

机构信息

Department of Diagnostic Radiology, Xinjiang General Hospital of PLA, Urumqi 830000, P.R.China;Medical Station of Sanshili Barracks, PLA 950 Hospital, Hetian, Xinjiang 845150, P.R.China.

Department of Clinical Laboratory, Xinjiang General Hospital of PLA, Urumqi 830000, P.R.China;Medical Station of Sanshili Barracks, PLA 950 Hospital, Hetian, Xinjiang 845150, P.R.China.

出版信息

Sheng Wu Yi Xue Gong Cheng Xue Za Zhi. 2020 Dec 25;37(6):1031-1036. doi: 10.7507/1001-5515.202007043.

Abstract

To investigate the computed tomography (CT) characteristics and differential diagnosis of high altitude pulmonary edema (HAPE) and COVID-19, CT findings of 52 cases of HAPE confirmed in Medical Station of Sanshili Barracks, PLA 950 Hospital from May 1, 2020 to May 30, 2020 were collected retrospectively. The size, number, location, distribution, density and morphology of the pulmonary lesions of these CT data were analyzed and compared with some already existed COVID-19 CT images which come from two files, "Radiological diagnosis of COVID-19: expert recommendation from the Chinese Society of Radiology (First edition)" and "A rapid advice guideline for the diagnosis and treatment of 2019 novel corona-virus (2019-nCoV) infected pneumonia (standard version)". The simple or multiple ground-glass opacity (GGO) lesions are located both in the HAPE and COVID-19 at the early stage, but only the thickening of interlobular septa, called "crazy paving pattern" belongs to COVID-19. At the next period, some increased cloudy shadows are located in HAPE, while lesions of COVID-19 are more likely to develop parallel to the direction of the pleura, and some of the lesions show the bronchial inflation. At the most serious stage, both the shadows in HAPE and COVID-19 become white, but the lesions of HAPE in the right lung are more serious than that of left lung. In summary, some cloudy shadows are the feature of HAPE CT image, and "crazy paving pattern" and "pleural parallel sign" belong to the COVID-19 CT, which can be used for differential diagnosis.

摘要

为探讨高原肺水肿(HAPE)与新型冠状病毒肺炎(COVID-19)的CT特征及鉴别诊断,回顾性收集2020年5月1日至2020年5月30日解放军第九五〇医院三十里营房医疗站确诊的52例HAPE患者的CT表现。分析这些CT数据中肺部病变的大小、数量、位置、分布、密度及形态,并与来源于《新型冠状病毒肺炎影像学诊断:中华放射学会专家共识(第一版)》及《新型冠状病毒感染的肺炎诊疗快速建议指南(标准版)》两个文件中的部分COVID-19 CT图像进行对比。早期HAPE与COVID-19均可见单发或多发磨玻璃密度影(GGO),但只有小叶间隔增厚的“铺路石征”属于COVID-19。后期,HAPE可见部分新增云雾状阴影,而COVID-19的病变更易沿胸膜方向发展,部分病变可见支气管充气征。最严重阶段,HAPE与COVID-19的阴影均呈白色,但HAPE右肺病变较左肺更严重。综上所述,部分云雾状阴影为HAPE的CT影像特征,“铺路石征”及“胸膜平行征”属于COVID-19的CT表现,可用于二者的鉴别诊断。

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High altitude reduces infection rate of COVID-19 but not case-fatality rate.高海拔降低 COVID-19 的感染率,但不能降低病死率。
Respir Physiol Neurobiol. 2020 Oct;281:103494. doi: 10.1016/j.resp.2020.103494. Epub 2020 Jul 15.
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COVID-19 Lung Injury is Not High Altitude Pulmonary Edema.新冠病毒肺炎所致肺损伤并非高原肺水肿。
High Alt Med Biol. 2020 Jun;21(2):192-193. doi: 10.1089/ham.2020.0055. Epub 2020 Apr 13.
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High-altitude pulmonary edema.高原肺水肿。
Compr Physiol. 2012 Oct;2(4):2753-73. doi: 10.1002/cphy.c100029.

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