白塞病并发肺血管病变的多层螺旋CT表现

Manifestations of pulmonary vascular lesions in Behcet’s disease by multislice spiral computed tomography

摘要:

目的 探讨白塞病并发肺血管病变的多层螺旋计算机断层扫描（MSCT）诊断要素及特点。方法 回顾性地分析2012年3月至2014年4月复旦大学附属华东医院和同济大学附属肺科医院收治的13例白塞病合并肺血管病变患者的临床及影像学资料，分析其临床和CT表现的特点。结果 13例患者CT显示肺血管栓塞11例（10例同时合并肺动脉瘤）、弥漫性肺小管炎1例、肺出血1例，其中9例合并心包积液、6例合并胸腔积液、8例合并纵隔淋巴结肿大、1例合并心脏及下腔静脉血栓形成。胸部MSCT结合肺动脉造影（CTPA）三维重建技术可清晰地显示以上病变的各种表现：肺动脉瘤表现为肺动脉的局限性扩张，扩张部分的强化程度和方式与正常肺动脉相仿；肺血管栓塞表现为强化的肺动脉腔内充盈缺损影；弥漫性肺小血管炎表现为多发棉絮状磨玻璃影；肺出血表现为以出血部位为中心的磨玻璃影。结论 白塞病合并肺血管病变的CT表现多样，MSCT对诊断白塞病合并肺血管病变有重要价值，可作为检查与常规随访的首选手段。

Abstract:

Objective To investigate the diagnostic elements and characteristics of pulmonary vascular lesions in patients with Behcet’s disease by multislice spiral computed tomography (MSCT). Methods CT images and medical data of 13 patients with pulmonary vascular lesions of Behcet’s disease in Huadong Hospital and Pulmonay Hospital from March 2012 to April 2014 were collected and retrospectively reviewed. Their clinical characteristics and CT image features were analyzed. Results Among the patients, MSCT scanning showed that there were 11 cases of pulmonary embolism (10 of them complicated with pulmonary artery aneurysms), 1 case of diffuse capillary vasculitis and 1 case of pulmonary hemorrhage. Besides, there were 9 cases of pericardial effusion, 6 cases of pleural effusion, 8 cases of mediastinal enlarged lymph nodes, and 1 case of thrombosis in cardiac chambers and inferior vena cava. MSCT combined with computed tomographic pulmonary angiography and three-dimensional reconstruction techniques clearly displayed above lesions. The pulmonary artery aneurysm manifested as dilation of the pulmonary artery, which was similar to that of the normal pulmonary artery in enhancement. Filling defect in the pulmonary artery was found in CT images of pulmonary embolism. Diffuse pulmonary vasculitis manifested as multiple cotton-wool and ground glass appearance on CT image. The performance of pulmonary hemorrhage was the ground glass opacity around the bleeding site. Conclusion Behcet’s disease complicated with pulmonary vascular disease shows a variety of manifestations on CT images. MSCT is of great value in the diagnosis of Behcet’s disease complicated with pulmonary vascular disease, and should be used as the first option in its examination and regular follow-up.