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.
• Having history of contact with flu chicken. She looked after her daughter who had died of acute atypic pneumonia (H5N1 conftal just 2 days before.
• 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.
DR）可提高图像的质量、可防止交叉感染
入院时
入院3天后
人禽流感肺炎的影像表现
▶人禽流感未引起肺部病变时X线胸片所见正常。
▶当引起肺炎时出现胸部异常影像： （1）病变形态：人禽流感肺炎的基本影像表现是
肺内片状影像，病变形态可表现为斑片状、大片状
及斑片融合影像，边缘模糊。病变密度呈肺实变或 磨玻璃密度，可见“空气支气管征”。肺纹理增粗 模糊。 （2）病变部位：病变位于一侧或两侧肺部，上、
• 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.
• 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.
• 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.
• 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.
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
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.
• 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.
• 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.
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.
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检查主要用于肺炎合并症的诊断以及X线
诊断困难的病例。 ▶肺炎的病原诊断需根据临床及病原学检查 ▶影像检查可以提供鉴别诊断的可能范围 ▶数字化的影像技术具有较高的应用价值（CR、
• 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%.
looked after her brother who had died with diagnosis of acute atypic pneumonia (no sample collected) just 3 days before. Main complains: High sudden fever, dry cough, headache, no shortness of breath. Physical examination: temp 39.90C, pulse 90, BP 110/60, RR 20/min. Oxygen saturation 98%. Other signs were normal. Lab findings on admission: WBC 4.8 G/L, (67% neutrophils), platelets 139 G/L, BUN 3.3mmol/l. Chest X-ray :“ no remarkable changes”.
Case report 1