支气管胸膜瘘
患者术后经胸腔插管引流,但平片示液气胸持续存在,故行CT平扫:
根据目前的平片与CT,液气胸持续存在最可能的原因是(单选)?
1、手术所致空气、液体残留,胸膜反应,属正常情况,继续引流即可;
2、术后胸膜腔产气菌感染,化脓性炎症;
3、支气管胸膜瘘
4、食管胸膜瘘
Findings
Unenhanced chest CT shows a righthydropneumothorax with a direct communication between the right lower lobebronchial tree and the pleural space.
平扫CT显示:右侧液气胸,右下叶支气管与胸膜腔直接相通(箭)
Differential diagnosis 鉴别诊断:
Bronchopleural fistula 支气管胸膜瘘
Empyema 脓胸
Esophagopleuralfistula 食管胸膜瘘
诊断:支气管胸膜瘘
A bronchopleuralfistula (BPF) refers to an abnormal communication between the pleural space andbronchial tree.
Mostoften due to pulmonary resection and occurs in up to 9% of pneumonectomies.
Morecommon after right-sided pneumonectomy.
Predisposingfactors include uncontrolled preoperative pleuropulmonaryinfection, trauma, preoperative radiation therapy, and postoperativeventilation.
Signs/symptomsmay include purulent sputum, fever, cough, chest pain, or large air leak frompleural drainage tubes.
Associatedmortality rate of 16% to 23% has been reported.
Upto a third of BPFs may close spontaneously; however, surgery is usuallynecessary.
支气管胸膜瘘(BPF)指胸膜腔与支气管树之间异常交通。最常见于肺切除术后,发生率约9%,更多见于右肺手术后。发病诱因包括:手术前未控制的胸膜-肺部感染、创伤、术前放疗、术后机械通气.临床表现可包括脓痰、发热、咳嗽、胸痛,或从胸腔引流管排除大量空气。据报道死亡率达到16%-23%。
1/3 BPF可自愈,但通常需要外科手术。
Persistent or progressive pneumothoraxdespite adequate tube drainage.Increased air and decreased fluid in thepostpneumonectomy space.Sudden pneumothorax or reappearance ofair in a previously opaque postpneumonectomy space.CT may allow direct visualization offistula.
Contrast administered directly intopleural collection may be visible in airways.
影像学表现:
持续或渐进性存在的气胸,尽管经过充分的引流;肺切除术后胸腔空气增多、液体减少.在之前肺切除术后的不透明空间突发气胸或再现空气.CT或许直接显示瘘管.将造影剂直接注入胸膜腔,或许会在气道中见到造影剂。
Differential diagnosis
鉴别诊断:
脓胸:BPF可为脓胸的病因,也可与脓胸并发;增强扫描可见胸膜增厚。
食道胸膜瘘:影像学表现与BPF类似,通常需要食道内镜确定食道破裂部位。
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