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引用次数: 0
摘要
传统的 X 光图像是疑似肺炎的首选方法。计算机断层扫描(CT)适用于难治性或复发性浸润、难以鉴别诊断、疑似并发症以及免疫力低下的患者。胸部超声波检查可作为初步诊断的替代方法,在重症监护室中也可用于监测病情进展。除了检测浸润外,放射学分类还有助于限制病原体的范围。从放射学角度看,肺炎主要可分为三种形式:大叶性肺炎、支气管肺炎和间质性肺炎。此外,某些病原体(如曲霉菌瘤、侵袭性霉菌病、原发性肺结核后遗症和非结核分枝杆菌病)或特定临床环境(如吸入性肺炎、梗塞后肺炎、潴留性肺炎和化脓性栓塞)也会导致特殊形式的肺炎。肺炎最常见的并发症是肺脓肿和胸腔积液。这两种情况有时都能在 X 光图像中看到,但并非总是如此。如果临床上有疑似情况,应严格按照 CT 的适应症进行检查。某些原有疾病,如免疫缺陷或肺部结构改变,可能会导致肺部感染,经常会有不同寻常的病原体或表现形式,因此在诊断时必须加以考虑。
The conventional X‑ray image is the method of choice for suspected pneumonia. Computed tomography (CT) is indicated for treatment refractory or recurrent infiltrates, difficult differential diagnostics, suspected complications and in immunocompromised patients. Thoracic sonography can be used as an alternative method for initial diagnostics and in the intensive care unit to monitor progress. In addition to the detection of infiltrates the radiological classification can help to limit the pathogen spectrum. Radiologically, three forms of pneumonia can principally be differentiated: lobar pneumonia, bronchopneumonia and interstitial pneumonia. Furthermore, there are special forms of pneumonia with certain pathogens, such as aspergilloma, invasive mycosis, postprimary tuberculosis and nontuberculous mycobacteriosis or in a specific clinical context, such as aspiration pneumonia, postinfarction pneumonia, retention pneumonia and septic emboli. The most frequent complications of pneumonia are lung abscesses and pleural empyema. Both can sometimes but not always be seen in the X‑ray image. If clinically suspected the indications for CT should be generously applied. Certain pre-existing diseases, such as immunodeficiency or structural alterations of the lungs can predispose to pulmonary infections, frequently with unusual pathogens or manifestation forms and must be taken into account in the diagnostics.
期刊介绍:
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