CT平扫可发现肺栓塞?看看国外高手是怎么做到的

2019-06-12 孙丹雄 小小医生之有趣的医学

让我们通过病例来学习如何通过胸部CT来发现和诊断肺栓塞。

胸部高分辨CT平扫,可发现肺栓塞,甚至国外有高手在某些情况下直接拿来诊断肺栓塞。哎,看世界纷纷扰扰,刀光剑影,高手出招,总让人耳目一新。

今天把近期整理的文献和大家分享,期望与大家一起探讨。先上病例,我喜欢在病例分析中学习。

病例一

作者单位:Department of Radiology, Thoracic Imaging Section, San Francisco General Hospital(旧金山总医院)。



如图,高密度影的那一条。
不怕,有增强CT证实。



是不是很有趣。
再来一个图。



仔细看,有端倪。
增强CT可以核实。



很明显,患者做了CT平扫,我们要仔细阅片,发现可疑,及时增强CT,要不然就漏诊了。

上面图片的英文原版
↓↓↓



病例二

作者单位:Department of Radiology, University of Washington MedicalCenter, University of Washington School of Medicine(华盛顿医科大学)。

翠花上菜,学者上图。



发现嫌疑犯,立即逮捕。



增强CT对比,一目了然。



上面的患者,增强CT放大了。
下面是另外一个
↓↓↓



星号的地方。




再来一个





很明显:扯蛋肺栓塞。



没看够?
再来一个,让你一次看个够。





不光是肺栓塞,连主动脉夹层,都发现了。
牛。我来标记一下。





究竟是美国的设备好,还是他们认真仔细?两者相辅相成。生产工具很重要,人的努力也很重要。

另外,社会要和谐。

老外报道一例患者,门诊急诊CT平扫发现肺栓塞,但是患者危重,再次外出做增强CT很危险,别人直接高分辨CT诊断肺栓塞,直接治疗,病情缓解再出去检查。在中国,你懂的(抱歉:有些文献下载要钱,穷,没有下载到)。

病例三:

其实,我大中华也有医生用CT平扫发现可疑肺栓塞。

下面是上海交通大学的论文
↓↓↓



基本上看得到。

病例四:

再介绍一位牛人:首都医科大学,附属北京友谊医院,放射科主任医师,李铁一教授。以前买过一本他的书。当时在读研究生,刚好有点钱,就买了,可惜书太老,图像不清楚,但书写得很好。

2004年,李铁一教授就说了:对于不能使用对比剂或因非典型心肺症状而仅作平扫的病例,肺动脉CT平扫的异常密度改变能提示急性肺动脉栓塞的存在。



中国的扫描仪质量有待提高,各位意会一下。

文献五

国外有高手专门研究了CT平扫诊断肺栓塞的可靠程度。

高分辨CT平扫管腔内高密度征象诊断肺栓塞的敏感性36.0%, 特异性99.0%,阳性预测值90.0%,阴性预测值85.6% 。

高分辨CT平扫管腔内高密度征象诊断中心肺栓塞敏感性66.7%, 特异性99.1%。

另外,CT发现肺纹理减少,也要警惕肺栓塞。先来说说马赛克。

马赛克征象:由于气道疾病或肺血管性疾病,引起相邻的肺区血液灌注上的差别而出现的不均匀肺密度区,称马赛克灌注。

以图说话,下面都是马赛克,注意了
↓↓↓









马赛克是什么意思,
就是马赛克存在的意义?
如图:



假如CT平扫发现肺部某些地方血管稀疏,灌注不足,千万不要以为没事,有时候,就是肺栓塞,需要警惕。

马赛克,需要警惕肺栓塞,它是肺栓塞的间接表现。并且,在临床中,间断会遇到这样的情况。



至于典型的“倒三角”要考虑肺栓塞,这些太经典,我就不赘述。


版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (5)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=904129, encodeId=d76d90412975, content=学习了,感谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201208/2b12108564cd4f528b86fdc17f359da9/9dbfd74f6e6341f3b2033d7d8383f74b.jpg, createdBy=366d5418345, createdName=运动康复治疗师, createdTime=Wed Dec 02 08:31:47 CST 2020, time=2020-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=900218, encodeId=517690021854, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/19A78ACCA514A62ED89322FF8BE440FD/100, createdBy=3fd82549592, createdName=一叶,一菩提, createdTime=Wed Nov 18 16:16:05 CST 2020, time=2020-11-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=893923, encodeId=070289392383, content=受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201019/bd6d2e6e6f694305bc0be2e1392cf1ce/e187adf778154291a9d464d8473e85fa.jpg, createdBy=2fbc5427229, createdName=ms3000002077686663, createdTime=Fri Oct 23 10:22:20 CST 2020, time=2020-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=881016, encodeId=1d7788101642, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=de3c5410793, createdName=蓝莓, createdTime=Sun Aug 30 19:16:01 CST 2020, time=2020-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1519003, encodeId=66f11519003a4, content=<a href='/topic/show?id=44275455fd' target=_blank style='color:#2F92EE;'>#CT平扫#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5455, encryptionId=44275455fd, topicName=CT平扫)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bb4811230693, createdName=shenxlcyp, createdTime=Fri Jun 14 07:48:00 CST 2019, time=2019-06-14, status=1, ipAttribution=)]
    2020-12-02 运动康复治疗师

    学习了,感谢

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=904129, encodeId=d76d90412975, content=学习了,感谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201208/2b12108564cd4f528b86fdc17f359da9/9dbfd74f6e6341f3b2033d7d8383f74b.jpg, createdBy=366d5418345, createdName=运动康复治疗师, createdTime=Wed Dec 02 08:31:47 CST 2020, time=2020-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=900218, encodeId=517690021854, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/19A78ACCA514A62ED89322FF8BE440FD/100, createdBy=3fd82549592, createdName=一叶,一菩提, createdTime=Wed Nov 18 16:16:05 CST 2020, time=2020-11-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=893923, encodeId=070289392383, content=受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201019/bd6d2e6e6f694305bc0be2e1392cf1ce/e187adf778154291a9d464d8473e85fa.jpg, createdBy=2fbc5427229, createdName=ms3000002077686663, createdTime=Fri Oct 23 10:22:20 CST 2020, time=2020-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=881016, encodeId=1d7788101642, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=de3c5410793, createdName=蓝莓, createdTime=Sun Aug 30 19:16:01 CST 2020, time=2020-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1519003, encodeId=66f11519003a4, content=<a href='/topic/show?id=44275455fd' target=_blank style='color:#2F92EE;'>#CT平扫#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5455, encryptionId=44275455fd, topicName=CT平扫)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bb4811230693, createdName=shenxlcyp, createdTime=Fri Jun 14 07:48:00 CST 2019, time=2019-06-14, status=1, ipAttribution=)]
    2020-11-18 一叶,一菩提

    学习

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=904129, encodeId=d76d90412975, content=学习了,感谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201208/2b12108564cd4f528b86fdc17f359da9/9dbfd74f6e6341f3b2033d7d8383f74b.jpg, createdBy=366d5418345, createdName=运动康复治疗师, createdTime=Wed Dec 02 08:31:47 CST 2020, time=2020-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=900218, encodeId=517690021854, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/19A78ACCA514A62ED89322FF8BE440FD/100, createdBy=3fd82549592, createdName=一叶,一菩提, createdTime=Wed Nov 18 16:16:05 CST 2020, time=2020-11-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=893923, encodeId=070289392383, content=受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201019/bd6d2e6e6f694305bc0be2e1392cf1ce/e187adf778154291a9d464d8473e85fa.jpg, createdBy=2fbc5427229, createdName=ms3000002077686663, createdTime=Fri Oct 23 10:22:20 CST 2020, time=2020-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=881016, encodeId=1d7788101642, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=de3c5410793, createdName=蓝莓, createdTime=Sun Aug 30 19:16:01 CST 2020, time=2020-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1519003, encodeId=66f11519003a4, content=<a href='/topic/show?id=44275455fd' target=_blank style='color:#2F92EE;'>#CT平扫#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5455, encryptionId=44275455fd, topicName=CT平扫)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bb4811230693, createdName=shenxlcyp, createdTime=Fri Jun 14 07:48:00 CST 2019, time=2019-06-14, status=1, ipAttribution=)]
    2020-10-23 ms3000002077686663

    受益

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=904129, encodeId=d76d90412975, content=学习了,感谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201208/2b12108564cd4f528b86fdc17f359da9/9dbfd74f6e6341f3b2033d7d8383f74b.jpg, createdBy=366d5418345, createdName=运动康复治疗师, createdTime=Wed Dec 02 08:31:47 CST 2020, time=2020-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=900218, encodeId=517690021854, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/19A78ACCA514A62ED89322FF8BE440FD/100, createdBy=3fd82549592, createdName=一叶,一菩提, createdTime=Wed Nov 18 16:16:05 CST 2020, time=2020-11-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=893923, encodeId=070289392383, content=受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201019/bd6d2e6e6f694305bc0be2e1392cf1ce/e187adf778154291a9d464d8473e85fa.jpg, createdBy=2fbc5427229, createdName=ms3000002077686663, createdTime=Fri Oct 23 10:22:20 CST 2020, time=2020-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=881016, encodeId=1d7788101642, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=de3c5410793, createdName=蓝莓, createdTime=Sun Aug 30 19:16:01 CST 2020, time=2020-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1519003, encodeId=66f11519003a4, content=<a href='/topic/show?id=44275455fd' target=_blank style='color:#2F92EE;'>#CT平扫#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5455, encryptionId=44275455fd, topicName=CT平扫)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bb4811230693, createdName=shenxlcyp, createdTime=Fri Jun 14 07:48:00 CST 2019, time=2019-06-14, status=1, ipAttribution=)]
    2020-08-30 蓝莓

    学习

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=904129, encodeId=d76d90412975, content=学习了,感谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201208/2b12108564cd4f528b86fdc17f359da9/9dbfd74f6e6341f3b2033d7d8383f74b.jpg, createdBy=366d5418345, createdName=运动康复治疗师, createdTime=Wed Dec 02 08:31:47 CST 2020, time=2020-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=900218, encodeId=517690021854, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/19A78ACCA514A62ED89322FF8BE440FD/100, createdBy=3fd82549592, createdName=一叶,一菩提, createdTime=Wed Nov 18 16:16:05 CST 2020, time=2020-11-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=893923, encodeId=070289392383, content=受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201019/bd6d2e6e6f694305bc0be2e1392cf1ce/e187adf778154291a9d464d8473e85fa.jpg, createdBy=2fbc5427229, createdName=ms3000002077686663, createdTime=Fri Oct 23 10:22:20 CST 2020, time=2020-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=881016, encodeId=1d7788101642, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=de3c5410793, createdName=蓝莓, createdTime=Sun Aug 30 19:16:01 CST 2020, time=2020-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1519003, encodeId=66f11519003a4, content=<a href='/topic/show?id=44275455fd' target=_blank style='color:#2F92EE;'>#CT平扫#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5455, encryptionId=44275455fd, topicName=CT平扫)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bb4811230693, createdName=shenxlcyp, createdTime=Fri Jun 14 07:48:00 CST 2019, time=2019-06-14, status=1, ipAttribution=)]

相关资讯

Eur Heart J:低风险肺栓塞患者右心功能不全或升高的心脏生物标志物预后价值

由此可见,在急性PE的低风险患者中,入院时RV功能障碍与早期死亡率相关。该研究的结果可能对单独根据临床标准确定低风险患者的治疗管理产生影响,但RV功能障碍是根据影像学结果或实验室标志所确定的。

肺栓塞患者行大脑镰旁脑膜瘤切除术麻醉管理1例

患者,女,62岁,身高165 cm,体质量65kg,BMI:24kg/m2。术前诊断:(1)左顶大脑镰旁脑膜瘤;(2)肺动脉栓塞;(3)高血压病(3级,高危)。拟在全身麻醉下行左顶大脑镰旁脑膜瘤切除术。患者主诉:右侧肢体不自主抖动伴无力7月余,加重11d,由于右侧偏瘫患者卧床1月余。既往有慢性肺动脉栓塞史5年(具体原因不详),长期口服华法林;高血压病史3年,口服苯磺酸氨氯地平片。

当肺栓塞合并出血:要不要止血?该不该抗凝、溶栓?

肺栓塞的治疗方法以内科治疗为主,其中抗凝与溶栓治疗是主要手段。常用的抗凝药物包括普通肝素、低分子肝素、华法林、非维生素K拮抗剂类口服抗凝药(利伐沙班、达比加群等),常用溶栓药物包括重组组织型纤溶酶原激活剂(rt-PA)、尿激酶、链激酶等。以上这些药物通过抗凝、促进纤维蛋白溶解起到治疗肺栓塞的作用,而其最大不良反应即是各种出血,包括伴有严重后果的大出血、以及临床相关的非大出血等。

Ann Rheum Dis:强直性脊柱炎的静脉血栓栓塞风险

这些研究结果表明,一般AS人群的VTE风险升高。这种风险在诊断后的第一年最为突出。

Chest:王辰、翟振国教授团队再发文——近10年中国VTE人群患病率上升,而病死率显著下降

时隔一月,国际呼吸领域知名期刊Chest(影响因子IF=7.652)杂志再次正式在线发表王辰院士、翟振国教授团队关于中国人群静脉血栓栓塞症(含肺栓塞与深静脉血栓形成)近十年的流行病学大数据。

NEJM:妊娠适应的YEARS算法诊断疑似肺栓塞

由此可见,妊娠适应的YEARS诊断算法在妊娠全程可安全地排除了肺栓塞,其可使32%至65%的患者中避免了CT肺血管造影。