肺隐球菌病的CT诊断及病理对照  

CT Diagnosis and Pathology Correlation of Pulmonary Cryptococcosis

作　　者：谭国强[1] 龙晚生[1] 马雁秀[1] 崔恩铭[1] 李卓永[1] 张朝桐[1] 兰勇[1] 胡茂清[1] 

机构地区：[1]江门市中心医院放射科,529071

出　　处：《临床放射学杂志》2013年第9期1272-1275,共4页Journal of Clinical Radiology

摘　　要：目的探讨肺隐球菌病（PC）的cT表现及病理特点，提高术前诊断水平，减少误诊。方法回顾分析2007至2012年本院经手术病理确诊的18例Pc患者的CT表现，并与病理进行对照分析。结果18例PC患者中，男13例，女5例，年龄36～61岁，中位年龄43岁。临床症状轻，5例为体检发现；10例咳嗽、咳痰；3例胸痛不适；3例合并糖尿病、1例合并系统性红斑狼疮等基础性疾病。所有患者均行CT平扫、高分辨及增强扫描。18例患者中：（1）多发病灶型（结节／团块）10例；（2）单发结节型：孤立性结节6例；（3）实变型：大叶楔形实变2例。所有结节或实变都位于邻胸膜下，16例呈宽基底状紧贴胸膜；结节／肿块边缘不规则，所有病例未见钙化。有6例出现厚壁空洞；2例周边出现“晕征”，1例小结节出现“胸膜凹陷征”；2例出现纵隔淋巴结肿大。增强扫描：16例出现不均一强化，内见散在低密度坏死灶；2例大叶实变病变内散在片状坏死液化灶；3例孤立结节呈周边强化，中间密度稍低。2例实性结节呈均一强化。病理：18例光镜下均表现为肉芽肿样病变。特殊染色六胺银及粘液卡红均可见新型隐球菌。结论PC的主要CT表现为结节．肿块位于肺外周并呈宽基底紧贴胸膜，病变内部以坏死为主且无钙化；但CT表现上缺乏特征性，易误诊为肺癌、普通肺炎或肺结核；经皮CT引导下穿刺活检有助于该病的早期诊断。Objective Objective To investigate the CT features and pathologic characteristics of pulmonary cryptococcosis （PC） , so as to improve its diagnostic accuracy. Methods The CT features of 18 cases with PC confirmed by surgical and pathology in our hospital from 2007 to 2012 were retrospectively reviewed and were compared with pathology. Results The 18 cases with PC consisted of 13 males and 5 females aged from 36 to 61 years, with a median age of 43. The clinical symptoms were light and the cases were diseovered during physical examination （5 cases）. Cough, phlegmin were occurred in 10 cases and chest pain in 3 cases. 3 cases had a history of diabetes and 1 case had systemic lupus erythematosus . Plain, high resolution and enhanced CT scan were performed in all the cases. Of the 18 cases, 10 cases showed the type of multiple nodules; 6 cases showed the type of solitary nodule, and 1 case showed lobar consolidation. All the lung nodules and consolidation were found in subpleural area, 16 cases cling to the pleura with wide basement, while the margin of nod- ules or the tumors were irregular, and no calcification were found in any case. 6 cases showed thick wall cavities. 2 cases showed halo sign around nodules, 1 case with small nodule showed pleural indentation sign. mediastinal lymphadenectasis was found in 2 cases. On the enhanced scan, 16 cases showed irregular enhancement, in which hypodensity necrosis inter- spersed. The patchy necrosis with liquefaction lesion in lobar consolidation was found in 2 cases, and enhancement around the solitary nodule with central hypodensity in 3 cases. 2 cases with solid nodules showed regular enhancement. Granuloma formation was found microscopically in 18 cases. Cryptococcosis neoformans was detected in all the cases by mucicarmine and grocott histopatholoical examination. Conclusion Peripheral pulmonary nodules clinging to the pleura with wide basement, necrosis in the lesion＇s internal are the main CT features of PC, but PC does not have any specific CT findings,

关 键 词：肺 隐球菌 病理 体层摄影术 X线计算机 

分 类 号：R519[医药卫生—内科学]