Zimmerman J E, Goodman L R, St Andre A C, Wyman A C
AJR Am J Roentgenol. 1982 Jan;138(1):59-64. doi: 10.2214/ajr.138.1.59.
A radiographic method for detecting excessive lung water in patients with pulmonary infiltrates of uncertain cause is described. The gravitational shift test uses bedside frontal films before and after prolonged lateral decubitus positioning. Excess lung water is identified by detecting a shift in infiltrate to the dependent lung while the opposite side clears or remains stable. The test was evaluated in 33 patients with infiltrates of well defined etiology. Twelve patients had heart failure or fluid overload (edema): 14 had pulmonary infection or parenchymal damage (inflammation); and seven had inflammation plus edema. Infiltrates shifted to the dependent lung in 85% of patients with lung edema, but did not shift in 78% of patients with inflammatory disease. The test also detected excess lung water in six of seven patients with underlying inflammatory disease. Each patient with a positive test showed clinical, physiologic, and radiographic improvement after therapy directed at mobilizing excessive lung water. When the differential diagnosis of a diffuse infiltrate is in question, a positive test represents a strong indication for a trial of diuretic therapy.
本文描述了一种用于检测病因不明的肺部浸润患者肺内积水过多的影像学方法。重力移位试验采用长时间侧卧位前后的床边正位片。通过检测浸润影向低位肺的移位，同时对侧肺野清晰或保持稳定来确定肺内积水过多。该试验在33例病因明确的浸润患者中进行评估。12例患者患有心力衰竭或液体超负荷（水肿）；14例患有肺部感染或实质损害（炎症）；7例患有炎症加水肿。85%的肺水肿患者浸润影移向低位肺，但78%的炎症性疾病患者浸润影未移位。该试验还在7例潜在炎症性疾病患者中的6例检测到肺内积水过多。每项试验阳性的患者在针对动员过多肺内积水的治疗后，临床、生理和影像学均有改善。当弥漫性浸润的鉴别诊断存在疑问时，试验阳性强烈提示可试用利尿剂治疗。
