原发性肺隐球菌病的CT影像和病理表现  

Analysis of CT images and pathological features of primary pulmonary cryptococcosis

作　　者：李晓光 谢宗玉[2] 康厚艺 毛怡 马强 张伟国 LI Xiao-guang;XIE Zong-yu;KANG Hou-yi;MAO Yi;MA Qiang;ZHANG Wei-guo(Department of Radiology,Daping Hospital,Army Medical University,Chongqing 400042;Department of Radiology,The First Affiliated Hospital of Bengbu Medical College,Bengbu Anhui 233004,China;Department of Pathology,Daping Hospital,Army Medical University,Chongqing 400042)

机构地区：[1]陆军军医大学大坪医院放射科,重庆400042 [2]蚌埠医学院第一附属医院放射科,安徽蚌埠233004 [3]陆军军医大学大坪医院病理科,重庆400042

出　　处：《蚌埠医学院学报》2019年第11期1513-1517,共5页Journal of Bengbu Medical College

基　　金：中央引导地方科技发展专项基金项目(YDZX20175000004270);重庆市影像医学与核医学临床医学研究中心项目(CSTC2015YFPT-gcjsyjzx0175)

摘　　要：目的:探讨原发性肺隐球菌病的CT影像表现和病理表现,提高该病术前诊断水平。方法:回顾性分析经病理证实的31例原发性肺隐球菌病的CT影像及病理结果。结果:31例中单发结节/团块型16例,多发结节/团块型6例,浸润实变型5例,混合型4例。21例(67.7%)位于肺外周胸膜下区,11例(35.3%)见"胸膜凹陷征",10例(32.3%)见"空气支气管征",9例(29.0%)见"毛刺征",8例(25.8%)见"晕征"。25例行增强扫描,6例见"血管造影征";其中21例呈轻中度强化(19例均匀,2例不均匀),4例呈重度均匀强化。病理上所有病灶表现为肉芽肿样病变,其内可见大量隐球菌孢子。结论:原发性肺隐球菌病CT表现多样,以肺外周胸膜下结节/团块多见,可伴"毛刺征""空气支气管征""晕征"及"胸膜凹陷征"和轻-中度均匀强化,有助于对其做出早期诊断。Objective:To observe the CT images and clinical pathological features of primary pulmonary cryptococcosis(PPC),so as to improve its diagnostic accuracy.Methods:The data of CT image and pathological features of 31 cases with PPC confirmed by histopathology were retrospectively analyzed.Results:Among 31 patientts,solitary nodule/mass in 16 cases,multiple nodules/mass in 6 cases,infiltrative consolidation in 5 cases and mixed type in 4 cases were identified.Among 31 cases,21 cases located in subpleural region(67.7%),11 cases showed pleural "indentation sign"(35.3%),10 cases showed "air bronchogram"(32.3%),9 cases showed "speculation"(29.0%) and 8 cases showed "halo sign"(25.8%),respectively.The enhanced CT scan in 25 cases were implemented,6 cases with "angiographic sign",21 cases with mild or moderate enhancement(including 19 cases with niform and 2 cases with uniform) and 4 cases with obvious homogeneous enhancement were found.Histopathologically,all lesions were granulomatous with abundant cryptococcal spores.Conclusions:The CT features of PPC are various,the nodules/masses in the subpleural area of lower lung are most common,which is complicated with "speculation","air bronehogram","halo sign",pleural indentation sign",mild or moderate homogeneous enhancement.These findings may be helpful for the preoperative diagnosis.

关 键 词：原发性肺隐球菌病 体层摄影 X线计算机 病理表现 

分 类 号：R445.3[医药卫生—影像医学与核医学]