CT Manifestations of Pulmonary Infarction Secondary to Acute Pulmonary Embolism
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摘要: 目的：探讨急性肺动脉栓塞（APE）继发肺梗死（PI）CT特征。方法：回顾性分析41例APE继发PI患者的临床及CT资料，总结PI的数量、位置、形态、边缘、胸腔积液及其动态变化特征。结果：PI的CT特征：①数量及位置：共79个PI病灶，18例患者为单发PI，23例患者为多发；所有PI病灶均位于胸膜下，与胸膜呈宽基底相连；46.8％（37/79）位于右肺下叶，36.7％（29/79）位于左肺下叶，右肺上叶、中叶分别为3.8％（3/79）、6.3％（5/79），左肺上叶舌段6.3％（5/79）。②形态：45.6％（36/79）病灶表现为反晕征（RHS），36.7％（29/79）为椭圆形、楔形及驼峰样实变，17.7％（14/79）为斑片状磨玻璃影。③支气管血管束包埋征：79.7％（63/79）病变内可见支气管血管束走行其中，21.3％（16/79）病变范围较小，其内未见明确支气管血管束走行、包埋。④增强后，79个PI病灶均未见强化。⑤治疗后期，所有PI病灶均演变为斑片或索条影。⑥胸腔积液：63.4％（26/41）患者出现胸腔积液，42.3％（11/26）为双侧胸腔积液，57.7％（15/26）单侧胸腔积液。结论：APE继发PI的CT表现具有一定特征性，胸膜下出现单发或多发病变，有反晕征、楔形或驼峰样实变、支气管血管束包埋特征时应考虑到PI，另外胸腔积液有助于诊断。Abstract: Objective: To investigate the CT findings of pulmonary infarction (PI) secondary to acute pulmonary embolism (APE). Method: The clinical and CT data of 41 patients with PI secondary to APE were analyzed retrospectively. The number, location, shape, margin of PI, pleural effusion and dynamic changes were summarized. Results: CT features of PI: (1) Number and location: Among the total 79 PI lesions, 18 patients had single lesion and 23 patients had multiple lesions. All lesions were located under the pleura and connected to the pleura with a broad base, 46.8% (37/79) were located in the lower lobe of the right lung, 36.7% (29/79) in the lower lobe of the left lung, 3.8% (3/79) in the upper lobe, 6.3% (5/79) in the middle lobe of the right lung, and 6.3% (5/79) in the lingual segment of the upper lobe of the left lung. (2) Shape: 45.6% (36/79) of the lesions showed Reversed Halo Sign (RHS), 36.7% (29/79) displayed consolidation of oval, wedge or hump, 17.7% (14/79) revealed ground glass opacity. (3) Bronchovascular bundles in PI: Bronchovascular bundles were found in 79.7% (63/79) of PI. In 21.3% (16/79) of the cases, there was no bronchovascular bundle in the lesion because of its small size; (4) After enhancement, there was no enhancement shown in the 79 PI lesions. (5) All 79 lesions changed into patchy or linear during the end of the treatment period. (6) Pleural effusion: 63.4% (26/41) of patients had pleural effusion, among whom 42.3% (11/26) had bilateral pleural effusion, and 57.7% (15/26) had unilateral pleural effusion. Conclusion: The imaging manifeatations of PE secondary to API hole certain characteristics. For single or multiple lesions under the pleura, with RHS, consolidation of wedge or hump, bronchovascular bundles, APE secondary to API should be considered. In addition, pleural effusion is helpful for diagnosis.
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图 1 女，70岁，胸痛，APE继发PI
（a）左肺下叶肺梗死，呈“反晕征”改变，内部为网格样磨玻璃密度影，周边为较薄的实性环，左侧胸腔少量积液；（b）CTPA示左下肺动脉及分支内大量栓子形成（红箭）及相应部位肺梗死（黄箭，与（a）箭头所示为同一病灶），左侧肋膈角少量胸腔积液；（c）治疗1个月后复查，反晕征演变为斑片实变影，胸腔积液消失。
Figure 1. A 70-year-old femal with chest pain and pulmonary infarction secondary to acute pulmonary embolism
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图 2 27岁，男，发热、腹痛，APE继发PI
（a）右肺下叶楔形肺梗死（箭头），内部密度不均，局部呈磨玻璃样改变，误诊为肺炎；（b）纵隔窗：肺梗死内散在小泡状气体密度影，为肺泡腔内残存气体，右侧胸腔少量积液（白箭）；（c）抗炎治疗13天后，右肺下叶前基底段病灶变实，边界锐利清晰（箭头）；（d）CTPA示右下肺动脉内栓子形成（红箭）及相应部位的楔形肺梗死（白箭）；（e）抗凝溶栓治疗1周后，CTPA示肺动脉栓塞范围较前减少，但肺梗死却较前增多，新出现右肺中叶椭圆形肺梗死（黄箭），其内侧可见支气管血管束包埋，右肺下叶驼峰样肺梗死（黑箭）；（f）抗凝溶栓治疗后期，右肺下叶肺梗死演变为小索条影（黑箭）。
Figure 2. A 27-year-old male with abdominal pain and fever and pulmonary infarction secondary to acute pulmonary embolism
表 1 41例APE继发PI患者的临床资料
Table 1 Clinical data of 41 patients with pulmonary infarction secondary to acute pulmonary embolism
项目 数量/例 比例/％ 项目 数量/例 比例/％ 病史 无特殊既往史 6 14.6 临床症状 胸痛 25 61.0 冠心病 9 22.0 呼吸困难 7 17.1 高血压 17 41.5 咯血 0 慢性阻塞性肺疾病 11 26.7 胸闷 5 12.2 糖尿病 4 9.8 咳嗽 14 34.1 肿瘤病史 7 17.1 发热 1 2.4 口服孕药 2 4.9 腹痛 5 12.27 系统性红斑狼疮 1 2.4 D-二聚体 0-1.5 mg/L（正常
参考范围）6 14.6 形成双下肢血栓 31 75.6 右心房血栓 2 4.9 ≥1.5mg/L 35 85.4 
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