新型隐球菌肺炎的临床、X线胸片与多层螺旋CT的分析  

The Clinical Manifestation,Chest X-ray and MSCT Findings of Pulmonary Cryptococcosis

作　　者：吕永革[1] 梁焕莲[1] 王建华[1] 黄春元[1] 杨茂洪[1] 罗帝林[1] 

机构地区：[1]广州医学院附属深圳沙井医院放射科,广东深圳518104

出　　处：《中国医学影像学杂志》2011年第6期424-428,共5页Chinese Journal of Medical Imaging

摘　　要：目的探讨新型隐球菌肺炎的临床及影像学表现。资料与方法回顾性分析16例新型隐球菌肺炎患者的临床、胸部X线片及多层螺旋CT表现。结果 16例新型隐球菌肺炎患者临床症状较轻,表现为不同程度的咳嗽、咳痰、气喘、胸背痛和低热;具有糖尿病史2例,肺结核病史4例。纤维支气管镜活检证实13例,CT定位穿刺活检证实3例。X线胸片表现为双中下肺野内结节状、肿块状及片块状实变阴影;实变影内空洞6例。多层螺旋CT显示肺内病灶分布、形态与胸片类似;"晕征"8例,支气管充气征9例,多发空洞11例,纵隔淋巴结轻度增大5例;病灶大部位于双中下肺,合并上肺病灶4例。结论新型隐球菌肺炎的临床症状与影像表现通常不符。多层螺旋CT比X线胸片提供更多信息,确诊有赖于纤维支气管镜或穿刺活检病理证实。Purpose To explore the clinical manifestation and imaging findings of pulmonary cryptococcosis . Materials and Methods The clinical data,chest X-ray film and multi-slice spiral CT（MSCT） findings of 16 cases of PC were retrospectively analysed. Results Sixteen cases of PC had mild clinical symptoms,such as cough,sputum,wheezing,thoracodorsal pain and low fever.Among the 16 cases, 2 was accompanied with diabetes and 4 combined with tuberculosis.13 cases were confirmed by fibroptic bronchoscopy,and 3 cases confirmed by percutancous cutting needle biopsy（PCNB）.The main signs of chest X-ray were nodular,mass and Sheet-block consolidation shadow in bilateral middle and lower lung fields,cavity in 6 cases.MSCT findings reveal that the distribution and shape of the nidus in the lungs were similar to chest X-ray; Halo signs were in 8 cases,air bronchogram in 9 cases,multiple cavity in 11 cases, and mild mediastinal lymphadenopathy in 5 cases.Most lesions of 16 cases were located in the middle or lower lungs ,which were merged with some lesions in the top lung in 4 cases.Conclusions Clinical symptoms are usually incompatible with imaging findings of pulmonary cryptococcosis.MSCT can provide more information than chest x-ray. The correct diagnosis depends on histopathologic by fiberoptic bronchoscopy and PCNB examination.

关 键 词：肺炎 细菌性 隐球菌 新型 放射摄影术 胸部 体层摄影术 螺旋计算机 

分 类 号：R563.119.045.4[医药卫生—呼吸系统]