普通型新型冠状病毒肺炎患者康复期胸部CT表现

CT findings of normal coronavirus disease 2019 patients during rehabilitation period

摘要:

目的：探讨普通型新型冠状病毒肺炎（coronavirus disease 2019，COVID-19）康复期患者胸部影像学表现。方法：收集2020年1月21日至2月23日孝感市第一人民医院确诊为普通型COVID-19的80例患者临床及影像资料，以体温恢复正常3 d以上、呼吸道症状明显好转、肺部影像学显示炎症明显吸收及连续2次呼吸道病原核酸检测阴性（采样时间至少间隔1 d）作为康复期出院标准，通过动态观察COVID-19康复期患者HRCT表现，与入院时进行对比分析，观察COVID-19患者典型征象及康复期出院时病变分布、病变形态等表现。结果：动态观察COVID-19康复期患者HRCT表现“破苍蝇拍征”及“包水管征”吸收减少，以“包水管征”吸收较早且明显。对比入院时HRCT，康复期表现以双肺下叶背段或后基底段局限斑片状磨玻璃灶、多叶多段磨玻璃样密度灶及弥漫分布的磨玻璃灶，部分患者残存小叶内间质及小叶间隔增厚、胸膜下弧线影及不规则纤维索条影灶，康复期患者未见明显纵隔淋巴结肿大和胸腔积液。结论：动态观察显示“破苍蝇拍征”及“包水管征”吸收减少是普通型COVID-19康复期病情好转的典型表现，康复期出院患者多遗留磨玻璃样改变、小叶内间隔和（或）小叶间隔增厚、胸膜下弧线影并残存间质炎症，临床随访应推广HRCT检查才能有效观察残存病灶的动态改变，降低残存病灶发生为间质纤维化的风险。

Abstract:

Objective：To investigate the chest imaging finding of patients with coronavirus disease 2019（COVID-19） in rehabilitation period. Methods：The clinical and imaging data of 80 patients with COVID-19 diagnosed as common type by the First People’s Hospital of Xiaogan City，Hubei Province from January 21，2020 to February 23，2020 were collected. The discharge standard of the convalescent stage contained body temperature returned to normal over 3 days，significant improvement of respiratory tract symptoms and obviously absorbed inflammation as well as two negative consecutive respiratory tract pathogenic nucleic acid tests showed by the pulmonary imaging（the time interval of taking sample was at least 1 day）. HRCT manifestations of patients were dynamically ob－served and were compared with those at the time of admission. Typical syndrome and lesion distribution and morphology at convales－cence stage were observed. Results：HRCT of COVID-19 patients in convalescent period showed that the absorption of “fly swatter breaking sign” and “water inclusion sign” was decreased，with earlier and more obvious absorption of water inclusion sign. Com－pared with HRCT at the time of admission，localized patchy ground glass foci in the dorsolateral or posterior basal segments of both lungs，multi segmented ground glass density foci and diffusely distributed ground glass foci in the convalescent stage were obvious，the remaining interlobular interstitial and interlobular septal thickening，subpleural arc shadow and irregular fibrous cord shadow foci among some patients were found and no obvious mediastinal lymphadenopathy and pleural effusion were found. Conclusion：The de－crease of absorption of “broken fly swatter sign” and “wrapped water pipe sign” is a typical manifestation of the improvement of the general COVID-19 in the rehabilitation period. In the rehabilitation period，the discharged patients often left ground glass like changes，thickening of interlobular septum and/or in－terlobular septum，subpleural arc shadow and residual intersti－tial inflammation. Only by popularizing HRCT in the clinical follow-up can effectively observe the dynamic changes of resid－ual lesions，reduce the residual lesions and lower the risk of de－veloping interstitial fibrosis.