肺毛霉菌病的CT表现及动态随诊  

CT findings and follow-up changes of pulmonary mucormycosis

作　　者：周红俐 刘范林 宋兰[1] ZHOU Hongli;LIU Fanlin;SONG Lan(Department of Radiology,Peking Union Medical College Hos pital,Beijing 100032,China;Department of Rad iology,Nanchong Central Hos pital,Nanchong,Sichuan Province 637000,China;Department of Radiology,Panzhihua Second People's Hospital,Panzhihua,Sichuan Province 617000,China)

机构地区：[1]北京协和医院放射科,北京100032 [2]南充市中心医院放射科,四川南充637000 [3]攀枝花市第二人民医院放射科,四川攀枝花617000

出　　处：《实用放射学杂志》2020年第8期1216-1219,1276,共5页Journal of Practical Radiology

摘　　要：目的探讨肺毛霉菌病(PM)的CT特征,包括其随诊动态变化,提高对该病的认识.方法回顾性分析9例经病理证实的PM患者的胸部CT表现及临床资料.所有患者均行MSCT平扫,5例行增强扫描.结果PM主要为双侧分布,肺叶、肺段分布无规律.2例为大片实变,7例以肿块、结节、实变的组合形式出现.病灶出现液化坏死7例,晕征6例,毛刺征5例(长毛刺为主),空洞及空泡征各4例,气-液平面、反晕征、分叶征(浅分叶为主)及点状钙化各2例,空气半月征1例.5例实性成分轻至中度强化,支气管受侵6例,淋巴结肿大5例,胸腔或心包积液6例,胸膜凹陷征4例.抗真菌治疗约1~2周病灶扩大,继而出现液化坏死及空洞,治疗约3~4周后逐渐好转,停药后病变进展3例.结论PM的CT表现形式多样,常伴晕征,强化程度低,易侵犯支气管,可出现类似肺癌的恶性征象,反晕征少见.PM治疗初期易出现影像学加重的假象,停药可致病变进展.Objective To discuss CT features of pulmonary mucormycosis(PM)including its follow-up changes,to improve the reoognition of this disease.Methods CT features and clinical data of 9 PM patients confirmed by pathology were analyzed retrospctively.All patients performed MSCT scan,among which 5 acepted enhanced examination.Results PM mainly located bilaterally with irregular pulmonary lobe and segments.2 cases had large patchy consolidation,while 7 cases showed the combination of lumps,nodules and consolidation.Others included 7 cases with liqvefactive necrosis,6 cases with halo sign,5 cases with spicule signs(mainly long spicule),4 cases with cavities and 4 cases with vacuoles,2 cases with vapor liquid surface,2 cases with reversed halo signs,2 cases with lobulation sign(mainly shallow lobulation),2 cases with punctate calcification,and 1 case with air crescent sign.There were also 5 cases with solid and moderate enhancement of solid ingredients,6 cases with bronchial invasion,5 cases with lymphadenopathy.6 cases with thoracic or pericardial effusion,and 4 cases with pleural indentation.After 1 to 2 weeks of antifungal therapy,the lesions continued to expand,followed by liquefactive necrosis as well as cavitation.After 3 to 4 wecks of treatment,the lesions were gradually on the mend,while the lesions of 3 cases worsened after drug discontinuance.Conclusion CT manifestation of PM is various,usully with halo signs.with low enhancement and with bronchus easily invaded.The lesions may show malignant sytmptoms of lung cancer,and the reversed halo sign is rare.In the early stage of PM treatment,the imaging aggravation is prone to occur.Withdrawal of drugs can cuse the progression of lesions.

关 键 词：肺毛霉菌病 计算机体层成像 

分 类 号：R563[医药卫生—呼吸系统] R814.42[医药卫生—内科学]