Clinical manifestations and CT distribution characteristics of imported COVID-19
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摘要:
目的分析上海市浦东新区输入性COVID-19的临床表现及CT分布特征。 方法回顾性分析经病毒核酸检查阳性的12例输入性COVID-19患者的临床及影像学资料,CT主要观察病变的数量、分布、形态、密度、边界、纵隔及胸膜等情况。 结果11例有疫区接触史,1例不详;10例有发热,9例有咳嗽;10例白细胞计数、中性粒细胞计数、淋巴细胞计数正常,7例单核细胞计数升高,10例嗜酸性粒细胞减低,2例C反应蛋白升高,3例血清淀粉样蛋白升高。CT分布特征:12例均为多发病灶,3例累及单个肺叶,3例累及两个肺叶,6例累及多个肺叶;肺下叶累及为主,有10例累及肺下叶;5例肺外周分布,7例肺外周及中心同时分布;胸膜受累11例,12例患者均未见胸腔积液和纵隔淋巴结增大;伴随征象为晕征1例,小叶间隔增厚2例,铺路石征1例,病变内支气管壁增厚、血管增粗7例,充气支气管征3例。 结论COVID-19患者临床表现主要为发热、咳嗽;实验室检查白细胞计数、中性粒细胞计数、淋巴细胞计数多正常,嗜酸性粒细胞计数减低;CT分布特征以肺下叶外周多发磨玻璃样影为主要表现。 Abstract:ObjectiveTo analyze the clinical manifestations and CT distribution characteristics of imported COVID-19 in Pudong, Shanghai. MethodsWe retrospectivly analyzed the clinical and imaging data of 12 cases of imported COVID-19 patients who were positive for viral nucleic acid examination. The number, distribution, morphology, density, boundary, mediastinum and pleura of the lesions were observed by CT. ResultsEleven cases had a history of exposure to the epidemic area and 1 case was unknown. Ten cases had fever and 9 with cough. Leukocyte counts, neutrophil counts and lymphocyte counts were normal in 10 cases. The monocyte counts was elevated in 7 cases, eosinophilia was decreased in 10 cases. Creactive protein was elevated in 2 cases, and serum amyloid was elevated in 3 cases. CT distribution features: all the 12 cases had multiple lesions, including 3 cases involving a single lobe, 3 cases involving two lobes, and 6 cases involving multiple lobes. The lower lobe of the lung was mainly involved, including 10 cases. Peripheral distribution was observed in 5 cases and peripheral distribution and central distribution in 7 cases. Pleural involvement in 11 patients, 12 patients did not see pleural effusion and mediastinal lymph node enlargement. We found 1 case of halo, 2 cases of interlobular septal thickening, 1 case of paving stone, 7 cases of inner bronchial wall thickening, 7 cases of blood vessel thickening, and 3 cases of air bronchogram. ConclusionThe clinical manifestations of COVID-19 patients are mainly fever and cough. In the laboratory, the leukocyte counts, neutrophil counts, lymphocyte counts are more normal and eosinophil counts decrease. The CT distribution is characterized by multiple ground hyaline shadows in the periphery of the lower lobe of the lung. -
Key words:
- COVID-19 /
- tomography /
- X-ray Computed
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图 1 输入性COVID-19患者的CT表现
A:患者女, 80岁, 确诊为COVID-19, 右肺上叶类圆形磨玻璃样影, 呈云雾状, 范围较局限; B:患者女, 25岁, 确诊为COVID-19, 左肺下叶胸膜下磨玻璃样影, 边界较清; C:患者女, 33岁, 确诊为COVID-19, 左肺下叶胸膜下见类圆形实变影, 内见充气支气管征象, 伴周围血管增粗; D:患者男, 39岁, 确诊为COVID-19, 右肺下叶见斑片状、条片状磨玻璃样影, 内伴实变, 部分纤维化, 表现为铺路石征; E:患者男,35岁, 确诊为COVID-19, 双肺下叶部分病灶内部可见实变影, 呈斑片状致密影夹杂周围磨玻璃影改变, 边界较清,范围较局限; F:患者女, 57岁,确诊为COVID-19, 右肺胸膜下散在多发磨玻璃样影, 部分实变, 呈楔形, 病灶内支气管壁增厚、血管增粗, 局部可见充气支气管征
Figure 1. CT findings of patients with imported COVID-19
表 1 12例COVID-19患者临床表现及实验室资料
Table 1. Clinical manifestations and laboratory data of 12 patients with COVID-19
患者编号 年龄(岁) 白细胞计数 中性粒细胞计数 淋巴细胞计数 单核细胞计数 嗜酸性粒细胞计数 发热 咳嗽 咳痰 咽痛 乏力 头痛 腹痛 腹泻 胸闷 恶心 1 5 - - - ↑ ↓ + + - - - - + - - - 2 16 ↓ ↓ - ↑ ↓ + + - + + + - - - - 3 25 - - - - - - - - - - - - - - - 4 27 - - - - ↓ + + - - - - - - - - 5 33 - - ↓ ↑ ↓ + + - - - - - - - - 6 35 - - - ↑ ↓ + - - - - - - - - - 7 39 - - - ↑ ↓ - + + - - - - - - - 8 50 - - - ↑ ↓ + + + + - - - - - - 9 51 - - - - - + + + - - - - - - - 10 57 ↓ ↓ - - ↓ + + - - - + - - - - 11 78 - - ↓ ↑ ↓ + + + - - - - - - - 12 80 - - - - ↓ + - - - + - - - + - 表 2 12例COVID-19患者CT特征
Table 2. CT features of 12 patients with COVID-19
患者编号 病变数量 病变分布 病变形态 病变密度 病变边界 纵隔及胸膜 伴随征象 1 多发 右肺中叶、下叶肺外周及中心 多种形态并存 磨玻璃+实性成分 模糊 胸膜受累 病变内支气管壁增厚、血管增粗 2 多发 右肺下叶肺外周及中心 斑片状、条片状 磨玻璃样 模糊 胸膜受累 小叶间隔增厚 3 多发 双肺下叶、右肺上叶肺外周及中心 斑片状、条片状 磨玻璃样 清晰 病变内支气管壁增厚、血管增粗 4 多发 双肺上叶、左肺下叶肺外周 多种形态并存 磨玻璃+性成分 模糊 胸膜受累 小叶间隔增厚病变内支气管壁增厚、血管增粗 5 多发 左肺下叶肺外周 楔形或扇形 实变 清晰 胸膜受累 支气管壁增厚、血管增粗充气支气管征 6 多发 双肺上叶、下叶肺外周及中心 多种形态并存 磨玻璃+实性成分 清晰 胸膜受累 病变内支气管壁增厚、血管增粗 7 多发 双肺上叶、右肺下叶肺外周及中心 多种形态并存 磨玻璃+实性成分 模糊 胸膜受累 铺路石征 8 多发 双肺上叶、左肺下叶肺外周 斑片状、条片状 磨玻璃样 模糊 胸膜受累 病变内支气管壁增厚、血管增粗 9 多发 双肺下叶肺外周 多种形态并存 磨玻璃+实性成分 模糊 胸膜受累 充气支气管征 10 多发 左肺下叶、右肺叶肺外周 楔形或扇形 磨玻璃+实性成分 清晰 胸膜受累 病变内支气管壁增厚、血管增粗 11 多发 双肺弥漫性病变肺外周及中心 楔形或扇形 磨玻璃+实性成分 模糊 胸膜受累 病变内支气管壁增厚、血管增粗 12 多发 右肺上叶肺外周及中心 斑片状、条片状 磨玻璃样 模糊 胸膜受累 晕征 -
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