AIDS相关肺部隐球菌感染的影像特征  

Imaging features of pulmonary cryptococcal infection associated with acquired immun deficiency syndrome

作　　者：赵月娟 赵思化 周树林 许红兰 赵晶 杨丹丹 张恩俊 ZHAO Yuejuan;ZHAO Sihua;ZHOU Shulin;XU Honglan;ZHAO Jing;YANG Dandan;ZHANG Enjun(Department of Radiology,Yunnan Provincial Infectious Diseases Hospital,Kunming 650301,China;Department of Tuberculosis,Yunnan Provincial Infectious Diseases Hospital,Kunming 650301,China;Department of Intensive Care Medicine,Yunnan Provincial Infectious Diseases Hospital,Kunming 650301,China;Department of Pneumology,Guandu District People's Hospital,Kunming 650000,China)

机构地区：[1]云南省传染病医院医学影像科,云南昆明650301 [2]云南省传染病医院结核科,云南昆明650301 [3]云南省传染病医院重症医学科,云南昆明650301 [4]云南省昆明市官渡区人民医院呼吸科,云南昆明650000

出　　处：《分子影像学杂志》2024年第5期518-522,共5页Journal of Molecular Imaging

基　　金：云南省科技厅科技重大专项计划(202102AA310005-20,202102AA310005-21)。

摘　　要：目的研究AIDS相关肺部隐球菌感染的临床特点和影像特征。方法分析云南省传染病医院2019年5月~2020年12月54例确诊AIDS相关隐球菌肺炎患者的临床特征和影像特点,54例患者中,男性38例,女性16例,年龄19~73(38.2±19.98)岁,所有患者的CT检查均采用同一检查设备及相同扫描参数,分析患者临床症状,CD4+计数,肺部病灶发病部位,肺部病灶的形态、大小、边缘以及肺外影像征象并总结其影像特征。结果54例患者中,CD4+计数为13~198/μL,中位计数为42/μL。临床特点:无症状8例(14.3%),发热37例(68.5%),咳嗽38例(70.4%),咳痰37例(68.5%),胸痛28例(51.9%),头痛40例(74.1%),恶心呕吐6例(11.1%),意识障碍5例(9.3%),合并隐球菌性脑膜炎40例(74.1%)。病灶分布:单发病灶6例(11.1%),多发病灶48例(88.9%),上叶33例(61.1%),中叶18例(33.3%),下叶36例(66.7%)。影像特点:结节或肿块影39例(72.2%),其中单发结节影6例(11.1%),多发结节影33例(61.1%),肿块影3例(5.6%),结节内空洞6例(61.1%),结节周围晕征3例(5.6%),毛刺12例(22.2%),浅分叶6例(11.1%);实变21例(37.5%);渗出20例(35.7%);空洞36例(66.7%),其中厚壁空洞6例(11.1%),薄壁空洞30例(55.6%);间质磨玻璃模糊影15例(27.8%);纵隔淋巴结肿大15例(27.8%);肺门淋巴结肿大13例(24.1%);胸膜腔积液0例(0%);多种病灶混合存在45例(83.3%)。结论AIDS相关隐球菌肺炎临床症状主要以发热,咳嗽,咳痰为主,CD4计数多低于200/μL;影像表现具有一定的特征性,病灶常多叶多发,肺外带多发常见;主要影像表现为结节、薄壁空洞、实变和磨玻璃影;胸膜腔积液极少见。Objective To analyze the clinical and imaging features of pulmonary cryptococcal infection complicated with AIDS,so as to improve the cognition of the disease.Methods The clinical and imaging features of 54 patients with AIDS complicated with cryptococcal pneumonia were analyzed retrospectively from May 2019 to December 2020,including 38 males and 16 females,with an average age of 19-73(38.2±19.98)years old.Results Among the 54 patients,CD4 count ranged from 13 to 198 cells/μL,with a median of 42 cells/μL.Clinical features:8 cases(14.3%)were asymptomatic,37 cases(68.5%)had fever,38 cases(70.4%)had cough,37 cases(68.5%)had expectoration,28 cases(51.9%)had chest pain,40 cases(74.1%)had headache,6 cases(11.1%)had nausea and vomiting,5 cases(9.3%)had disturbance of consciousness,and 40 cases(74.1%)had cryptococcal meningitis.Lesion distribution:6 cases had single lesions(11.1%),48 cases had multiple lesions(88.9%),involving the upper lobe in 33 cases(61.1%),the middle lobe in 18 cases(33.3%),and the lower lobe in 36 cases(66.7%).Imaging features:nodules or masses were present in 39 cases(72.2%),with single nodules in 6 cases(11.1%),multiple nodules in 33 cases(61.1%),masses in 3 cases(5.6%),intranodular cavitation in 6 cases(11.1%),halo sign around nodules in 3 cases(5.6%),spiculation in 12 cases(22.2%),ground-glass opacity in 6 cases(11.1%);consolidation in 21 cases(37.5%);effusion in 20 cases(35.7%);cavitation in 36 cases(66.7%),with thick-walled cavities in 6 cases(11.1%)and thin-walled cavities in 30 cases(55.6%);interstitial reticular opacity in 15 cases(27.8%);mediastinal lymphadenopathy in 15 cases(27.8%);hilar lymphadenopathy in 13 cases(24.1%);pleural effusion in 0 cases(0%);mixed lesions in 45 cases(83.3%).Conclusion Clinical symptoms of AIDS-related pulmonary cryptococcosis are mainly fever,cough,and sputum production,with most patients having CD4 counts below 200 cells/μL;imaging findings exhibit certain characteristics,with multi-lobed and multifocal lesions being common,along with nodules,thin-walle

关 键 词：AIDS 隐球菌肺炎 影像特征 

分 类 号：R512.91[医药卫生—内科学] R563[医药卫生—临床医学] R816.4