AIDS合并卡氏肺孢子菌肺炎的多排螺旋CT表现及鉴别诊断  

Multi slice spiral CT findings and differential diagnosis of AIDS complicated with Pneumocystis carinii pneumonia

作　　者：张健 陈平[1] 宋芹霞[1] 王安生[2] ZHANG Jian;CHEN Ping;SONG Qin-xia;WaNG An-sheng(Department of Rediology,Anqing Hospital Afiliated to Anhui Medical University,Anqing,Anhui 340811,China)

机构地区：[1]安徽医科大学附属安庆医院CT室,安徽安庆340811 [2]蚌埠医学院第一附属医院胸外科,安徽蚌埠233004

出　　处：《中华全科医学》2020年第11期1901-1903,共3页Chinese Journal of General Practice

基　　金：安徽医科大学临床科学基金项目(2019xkj233);安徽省高校自然科学研究重点项目(KJ2019A0311)。

摘　　要：目的分析艾滋病(AIDS)合并卡氏肺孢子菌肺炎(PCP)的多排螺旋CT(MSCT)表现特点,提高对本病的认识。方法回顾性分析2016年12月2019年8月安徽医科大学附属安庆医院临床确诊的24例AIDS合并PCP患者的肺部MSCT表现,对包括所有病例图像的磨玻璃影肺气囊、月弓征,肺间质改变以及肺门和纵隔淋巴结肿大、胸腔积液、气胸等征象进行观察统计,总结病变形态、密度及分布范围等特征。结果24例AIDS合并PCP患者的MSCT图像中,18例(75.0%)表现为两肺大致对称的磨玻璃样病变,以两侧肺门旁及中、下肺野分布为主,其中7例(29.2%)伴有渗出性病变且相互融合成斑片状实变阴影,10例(41.7%)有间质性改变,表现为小叶间隔增厚,双肺胸膜下线条或网格状阴影、铺路石征及间质纤维化改变,6例(25.0%)肺气囊,4例(16.7%)“月弓征”,肺外表现包括气胸1例(4.2%),胸腔积液1例(4.2%),心包积液2例(8.4%),纵隔或肺门淋巴结肿大2例(8.4%)。结论AIDS合并PCP的MSCT表现具有一-定特征性,当AIDS患者出现发热、干咳呼吸困难等症状,结合典型MSCT影像学表现可以考虑AIDS合并PCP诊断成立。Objective To analyze the multi slice spiral CT(MSCT) features of Pneumocystis carinii pneumonia(PCP) in patients with acquired immunodeficiency syndrome(AIDS), and to improve the cognition on the disease. Methods A retrospective analysis was conducted on the lung MSCT findings of PCP in 24 patients with AIDS diagnosed clinically by Anqing Hospital Affiliated to Anhui Medical University from December 2016 to August 2019. The ground glass opacity, pulmonary balloon, interstitial changes and mediastinal or lung hilar enlarged lymph nodes, pneumothorax, and pleural effusion were observed and counted. The features of the lesions such as the configuration, density and range of its distribution were summarizing. Results Among the 24 cases, 18 cases(75.0%) showed diffusing symmetrical lesions in both lungs, mainly in bilateral lung hilar, middle and lower lung fields. Among them, 7 cases(29.2%) had lesions of exudate and fused into patchy consolidation shadow, 10 cases(41.7%) had interstitial changes, presenting as thickens of interlobular septum, subpleural lines or reticulation, paving stone sign and fibrosis of interstitium, 6 cases(25.0%) had pulmonary balloon, 4 cases(16.7%) had "lunar arch sign". Extrapulmonary manifestations included 1(4.2%) pneumothorax, 1(4.2%) pleural effusion, 2(8.4%) pericardial effusion, and 2(8.4%) or lung hilar enlarged lymph nodes. Conclusion The MSCT manifestations of PCP in patients with AIDS have certain characteristics. When AIDS patients have fever, dry cough, dyspnea and other symptoms, combined with typical MSCT imaging manifestations, the diagnosis of AIDS combined with PCP can be considered.

关 键 词：艾滋病 卡氏肺孢子菌 肺炎 螺旋 计算机体层摄影 影像学诊断 

分 类 号：R512.91[医药卫生—内科学]