【摘要】：目的探討X線與CT診斷自發(fā)性縱隔氣腫的征象及價(jià)值。方法回顧性分析本院門(mén)診及呼吸科治療的自發(fā)性縱隔氣腫8例臨床資料,其中4例患者均進(jìn)行了CT及X線圖像攝片且經(jīng)CT確診。結(jié)果 CT圖像顯示縱隔內(nèi)沿氣管、支氣管、心臟、大血管及食管等組織結(jié)構(gòu)周?chē)g隙存在散亂的氣體影,前縱隔氣腫2例,中縱隔氣腫1例,后縱隔氣腫1例;伴有頸、胸部皮下氣腫2例,胸腔積液1例,肺窗圖像顯示胸膜被氣體向肺野方向不同程度推移。自發(fā)性縱隔氣腫的后前位X線圖像顯示縱隔結(jié)締組織間隙存在條狀氣體影,縱隔氣腫下擴(kuò)散至心臟及隔肌之間,導(dǎo)致雙側(cè)橫隔與縱隔呈現(xiàn)連續(xù)的充氣狀,側(cè)位X線片與正位X線片更易顯示縱隔形狀,表現(xiàn)為縱隔旁線條狀透亮影,胸骨與心臟間的透亮區(qū)增大,經(jīng)閱片醫(yī)師診斷,X線診斷準(zhǔn)確率為75%,CT診斷符合率為100%。結(jié)論后前位X線圖像顯示縱隔結(jié)締組織間隙存在條狀氣體影,縱隔氣腫下擴(kuò)散至心臟及隔肌之間及隔連續(xù)癥,在排除氣胸的情況下,診斷自發(fā)性縱隔氣腫有一定的特異性,X線憑借著方便、快捷、廉價(jià)的特點(diǎn)可作為早期篩查自發(fā)性縱隔氣腫,在高度懷疑的情況下,有條件的醫(yī)院應(yīng)采用CT明確診斷,條件不足的社區(qū)及基層醫(yī)院應(yīng)加攝側(cè)位胸片明確診斷。
[Abstract]:Objective to study the signs and value of X-ray and CT in diagnosis of spontaneous mediastinal emphysema. Methods the clinical data of 8 cases of spontaneous mediastinal emphysema treated in outpatient and respiratory department in our hospital were analyzed retrospectively. Results CT images showed that there were scattered gas shadows in mediastinal mediastinum along the space around the trachea, bronchus, heart, great blood vessel and esophagus, 2 cases of anterior mediastinal emphysema, 1 case of middle mediastinal emphysema, 1 case of posterior mediastinal emphysema, and 1 case of posterior mediastinal emphysema. There were 2 cases of subcutaneous emphysema and 1 case of pleural effusion. The posterior anterior X-ray images of spontaneous mediastinal emphysema showed that there were strip gas shadows in the space of mediastinal connective tissue, and the mediastinal emphysema spread between the heart and the septum, resulting in the bilateral mediastinal septum and mediastinum showing a continuous inflatable shape. Lateral and positive radiographs were easier to display mediastinal shape, showing parastastinal line transparency, enlarged clear area between sternum and heart. The accuracy of X-ray diagnosis by radiographs was 75% and the accuracy rate of CT diagnosis was 100%. Conclusion the posterior anterior X-ray images showed that there were strip gas shadows in the space of mediastinal connective tissue, and the mediastinal emphysema spread between the heart and septum and the septum continuous, and the pneumothorax was excluded. The diagnosis of spontaneous mediastinal emphysema has some specific X-ray features. It can be used as an early screening method for spontaneous mediastinal emphysema because of its convenient, fast and cheap features. In the case of high suspicion, the hospital with conditions should use CT to make a definite diagnosis. Community and primary hospitals with insufficient conditions should be diagnosed by lateral chest radiography.
【作者單位】： 佛山市順德區(qū)大良醫(yī)院放射科;
【分類號(hào)】：R564;R816.4

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