气道侵袭性肺曲霉病21例CT征象分析  

Analysis of CT signs in 21 cases of airway invasive pulmonary aspergillosis

作　　者：何家伟 谢扬虎[3] 王晓琼[4] 周璇[4] 盛茂[2] 王龙胜[1] HE Jiawei;XIE Yanghu;WANG Xiaoqiong;ZHOU Xuan;SHENG Mao;WANG Longsheng(Department of Radiology,Second Affiliated Hospital of Anhui Medical UniVersity,Medical Imaging Center of Anhui Medical University,Hefei 230061,China;Department of Imaging,The Second People’s Hospital of Hefei(Hefei Hospital Affiliated to Anhui Medical University),Hefei 230011,China;Department of Clinical Laboratory,The Second People’s Hospital of Hefei(Hefei Hospital Affiliated to Anhui Medical University),Hefei 230011,China;Department of Respiratory,The Second People’s Hospital of Hefei(Hefei Hospital Affiliated to Anhui Medical University),Hefei 230011,China)

机构地区：[1]安徽医科大学第二附属医院放射科,安徽医科大学医学影像中心,合肥230061 [2]合肥市第二人民医院(安徽医科大学附属合肥医院)影像中心,合肥230011 [3]合肥市第二人民医院(安徽医科大学附属合肥医院)检验科,合肥230011 [4]合肥市第二人民医院(安徽医科大学附属合肥医院)呼吸科,合肥230011

出　　处：《中国真菌学杂志》2024年第2期131-137,共7页Chinese Journal of Mycology

基　　金：安徽医科大学第二附属医院临床研究培育计划(2020LCZD18);合肥市应用医学项目(Hwk2023zd012)。

摘　　要：目的探讨气道侵袭性曲霉病(invasive pulmonary aspergillosis,IPA)的计算机断层扫描(computed tomography,CT)表现特点,旨在加强医师对气道IPA的认识并提高诊断水平。方法选取2018年8月—2023年6月在我院就诊的21例气道IPA,根据CT征象,分为3型,Ⅰ型累及小叶及段支气管,表现为支气管壁增厚;Ⅱ型病灶进一步发展,表现为小叶及段支气管扩张及周围实变;Ⅲ型累及细支气管及肺实质,细支气管壁增厚、周围树芽征及腺泡结节。详细分析3种类型的CT征象及鉴别诊断。结果21例气道IPA患者,Ⅰ型3例(14.3%),表现为段及小叶支气管管壁增厚,部分有树芽征及腺泡结节;Ⅱ型11例(52.4%),表现为段及小叶支气管扩张、周围实变;Ⅲ型7例(33.3%),表现为细支气管管壁增厚,周围树芽征、腺泡结节及斑片状模糊影。结论气道IPA具有特定的CT表现,掌握其CT分型及特征性征象,有助于临床早期诊断及治疗。Objective To investigate the performance characteristics of computed tomography(CT)with airway-invasive pulmonary aspergillosis(IPA),in order to enhance the awareness of airway IPA and improve the diagnosis.Methods 21 patients with airway IPA treated in our hospital from August 2018 to June 2023 were divided into three types according to CT characteristics.Type Ⅰ involved the segmental and lobular bronchi,which manifested as bronchial wall thickening.The lesion was further developed,type Ⅱ manifested as bronchiectasis and consolidation around the segmental and lobular bronchi.Type Ⅲ involved the bronchioles and pulmonary parenchyma,with bronchiolar wall thickening,tree-in-bud sign and acinar nodules around.Three types of CT signs and the differential diagnosis were analyzed in detail.Results 21 patients of airway IPA,3 patients(14.3%)had type Ⅰ,manifesting as thickening of lobular or segmental bronchial walls,some with tree-in-bud sign and acinar nodules around;11 patients(52.4%)had type Ⅱ,manifesting as segmental and lobular bronchiectasis and consolidation around the bronchus;and 7 patients(33.3%)had type Ⅲ,presenting as bronchiolar wall thickening,tree-in-bud sign,acinar nodules around and patchy blur.Conclusion Airway IPA has specific CT manifestations,and master its CT classification and characteristic signs,which is helpful for early clinical diagnosis and treatment.

关 键 词：CT 侵袭性肺曲霉病 真菌 

分 类 号：R519.8[医药卫生—内科学]