肺炎的X线表现和鉴别诊断

影像学检查在肺炎诊疗中的作用价值
X线平片是诊断肺炎的主要方法，其价值为： ▶可确定肺部有无病变 ▶可确定部位 ▶可确定范围 ▶了解病变的动态变化 ▶了解有无合并症 ▶观察治疗效果和判断预后
▶肺炎主要采用X线平片检查。
▶ CT检查主要病例。
▶肺炎的病原诊断需根据临床及病原学检查
Case 3
Case 3
Case 3
Case report 4
• Patient T.V.C male, 19 y/o living in Bac Giang province. • Admitted on 16/01/04. Discharged on 30/01/04. • Having no history of contact with flu chicken.. But many ill chicken died around area where patient was living. • Present history: 5 days of illness at home. High fever, sputum coughing and shortness of breath. He Admitted to Bac Giang provincial hospital, CXR showed serious lesions. The next day, condition became more critical with difficulty in breath and he was refered to NICRTM. • On admission: temp 38.50C, pulse 84, BP 110/70, RR 54/min, crackle rales in both 2 sides of lung. SaO2 82%. • Lab findings : WBC 3.9 G/L, (75.5% neutrophils), platelets 127 G/L, BUN 6.6mmol/l. • Chest X-ray : Opacities with unclear boundary over 2 lungs. • Management: Oxygen therapy with mask, Tamiflu, Axepim（头孢吡肟） Solumedrol. SaO2 was improved 91-95%. • Clinical course: After 2 days of treatment: Condition was improved. No longer fever or shortness of breath. SaO2 95-99%. Lab findings: WBC 10.8 G/l, GOT 148, GPT 194, LDH 1014. + Discharged on the day of 14th.
（3）病变的范围：早期病变为局限性片状阴影， 进展后呈多灶性或弥漫性分布，可累及一个或 多个肺段、肺叶，也可位于一侧肺或双肺。但 一般不按肺叶或肺段分布。 病灶进展快 ，重症 患者很快出现双肺弥漫性病变。 （4）动态变化：胸部影像表现变化较快。重症 患者肺内病变 进展迅速 ，短期内病灶明显增多， 从小片到大片，从单侧到双侧。病变密度也发 生明显的变化。在恢复过程中肺内病变的 吸收 也较快。
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Case 2
13.01.04
14.01.04
Case 2
16.01.04
19.01.04
Case 2
20.01.04
21.01.04
Case report 3
• Patient P.T.B. female, 30 y/o living in Ha Nam province. • Admitted on 05/01/04, died on 09/01/04. • Having history of contact with flu chicken. She looked after her daughter who had died of acute atypic pneumonia (H5N1 confirmed) at the Pediatrics Hospital just 2 days before. • Main complains: Feeling fatigue, fever, chest discomfort and shortness of breath. She went to provincial hospital and CXR was performed but no change on film. However, on the 3rd of the illness, respiratory distress quickly developed and she was refered to NICRTM. • On admission: temp 380C, pulse 90, BP 80/40, RR 30/min. Oxygen saturation 64%. • Lab findings : WBC 1.7 G/L, (63.5% neutrophils), platelets 66 G/L, BUN 14.3mmol/l. • Chest X-ray : changes with opacities unclear boundary infiltrations over 2 lungs . • Management: Oxygen therapy with mask but no effect, BiPAP ventilation was applied. SaO2 was around 83-90%. Antibiotics Axepim （头孢吡肟）, Solumedrol，Tequin and Dopamin（多巴胺） were ministered also.
Case 1
12.01.04
14.01.04
Case 1
16.01.04
19.01.04
Case 1
21.Jan.o4
23.Jan.o4
Case report 2
• • • • • Patient N.L.Hh. female, 23 y/o living in Thai Binh province. Admitted on 13/01/04, died on 23/01/04. She was older sister of the case 1. Main complains on admission: Fever, dry cough and diarrhea, no shortness of breath. Physical examination: temp 39.60C, pulse 100, BP 100/60, RR 20/min, no rales in both lungs. Oxygen saturation 99%. Other signs were normal. Lab findings on admission: WBC 5.6 G/L, (69% neutrophils), platelets 131 G/L, BUN 3.4mmol/l. Chest X-ray : no remarkable changes. Clinical course: On the 4th day : Became worse with continuous fever 390C, coughing, shortness of breath RR 40/min, crackle rales in both lungs, SaO2 was 86%. BP 100/60. WBC 3.5 G/l. GOT 77, GPT 40 U/l. Addition treatment with oxygen therapy by mask and antibiotics Axepim（头孢吡肟）， Tavanic, Zithromax and Solumedrol（甲强龙），But it seemed to be uneffected.
Case 4
Case 4
Case 4
Case report 5
• Patient L.T.H female, 20 y/o living in Bac Ninh province. • Admitted on 16/01/04. Discharged on 11/02/04. • Having history of contact with flu chicken.. Many ill chicken died around area where patient was living. • Present history: 7 days of illness at home. High fever, sputum coughing and shortness of breath. • On admission: temp 38.20C, pulse 120, BP 100/60, RR 58/min, crackle rales in both 2 sides of lung. SaO2 80%. • Lab findings : WBC 7.2 G/L, (87.3% neutrophils), platelets 211 G/L, BUN 3.7mmol/l. • Chest X-ray : Opacities with unclear boundary over 2 lungs. • Management: Oxygen therapy with mask, Tamiflu； Axepim（头孢吡肟） • Solumedrol（甲强龙） ，SaO2 was improved 91-95%. • Clinical course: After 3 days of treatment: Condition was improved. No longer fever or shortness of breath. SaO2 95-99%. Lab findings: WBC 10.8 G/l, GOT 37, GPT 84+ Discharged on the day of 26th.