结节肿块型肺隐球菌病的CT诊断及鉴别诊断

摘要/Abstract

摘要： 目的探讨多排螺旋CT对结节肿块型肺隐球菌病（pulmonary cryptococcosis,PC）的诊断价值。方法回顾性分析本院23例经病理证实的结节肿块型肺隐球菌病的胸部CT表现,其中16例患者行胸部CT平扫及增强扫描,7例仅行胸部直接增强扫描。分析病灶数目、大小、分布、密度、增强表现及伴随征象等。结果 23例患者中,单发结节或肿块7例,多发结节或肿块16例;共计276个病灶,其中结节病变267个,肿块病变9个。以肺外周带或胸膜下分布为主（20例）。16例行胸部CT平扫及增强扫描,其中不均匀强化12例（75%）、中度强化10例（62.5%）。结节或肿块型病灶均伴随多种CT征象,支气管充气征、肺血管纹理增粗深入、晕征、空泡或空洞、分叶征、毛刺征、胸膜凹陷征出现频率分别为65.2%、56.5%、30.4%、39.1%、52.2%、34.7%、4.3%。结论结节肿块型肺隐球菌病常分布于右肺外周带及胸膜下,肺血管纹理增粗深入病灶、支气管充气征及晕征为其较为特征性的CT表现。

关键词: 肺隐球菌病, 结节/肿块, 体层摄影术, X线计算机

Abstract: Objective To investigate the diagnostic value of the multi-slice spiral CT (MSCT) on diagnosing nodular or mass type pulmonary cryptococcosis(PC). Methods A total of 23 cases with nodular or mass type PC confirmed by pathological examinations in our hospital were retrospectively studied.Both plain and enhanced CT scans were performed for 16 patients, while direct enhanced CT scan was performed for 7 patients. The data including size,number,distribution and density of the lesions,performance of enhanced CT scan and accompanying signs were analyzed. Results Of all the 23 patients,there were 7 cases of single nodules/masses and 16 cases of multiple nodules/masses. There were totally 276 lesions with 267 nodules and 9 masses.The lesions were mainly found in outer zone or sub pleura of the lung(20 cases). Sixteen patients underwent both plain and enhanced CT scans,in which 12 cases(75%) showed heterogeneous enhancement and 10 cases(62.5%) showed moderate enhancement.Nodular or mass type lesions were accompanied by many CT signs including air bronc-hogram(65.2%,15/23),pulmonary vascular thickening(56.5%,13/23),halo sign(30.4%,7/23),pulmonary cavity or vocule sign(39.1%,9/23),lobulation sign(52.2%,12/23),spicule sign(34.7%,8/23),and pleural indentation(4.3%,1/23). Conclusions PC lesions usually occur in right lung and locations close to pleura.Pulmonary vascular thickening,air bronchogram and halo sign are the characteristic findings of CT manifestations in nodular or mass type PC.

Key words: Pulmonary cryptococcosis, Nodules/masses, Tomography, X-ray computed.

漆婉玲, 夏青, 李志, 李众, 何玉麟. 结节肿块型肺隐球菌病的CT诊断及鉴别诊断[J]. 新发传染病电子杂志, 2017, 2(1): 35-39.

QI Wan-ling, XIA Qing, LI Zhi, LI Zhong, HE Yu-lin. CT diagnosis and differential diagnosis of nodular or mass type pulmonary cryptococcosis[J]. Electronic Journal of Emerging Infectious Diseases, 2017, 2(1): 35-39.

参考文献

[1] 施毅,丁媛,苏欣,等.免疫功能正常患者肺隐球菌病临床诊治进展[J].中华内科杂志,2015,54(2):154-156.
[2] 刘又宁,佘丹阳,孙铁英,等.中国1998年至2007年临床确诊的肺真菌病患者的多中心回顾性调查[J].中华结核和呼吸杂志,2011,34(2):86-90.
[3] 骆静,刘士远,肖湘生,等.兔肺隐球菌病急性期CT表现与病理对照[J].实用放射学杂志,2013,29(5):831-834.
[4] 邵江,史景云,尤正,等.肺隐球菌病的CT表现[J].中华放射学杂志,2004,38(8):831-833.
[5] 黄进宝,李红艳,翁恒,等.56例原发性肺隐球菌病的临床分析[J].结核病与肺部健康杂志,2013,2(3):175-180.
[6] 秦志强,蒋玲玉,冯广弘,等.108例肺单个结节/肿块连续病例临床分析[J].重庆医学,2014,12(34):4649-4652.
[7] Leite D P,Amadio J V R S,Martins E R,et al.Cryptococcus spp isolated from dust microhabitat in Brazilian libraries[J].Journal of Occupational Medicine and Toxicology,2012,7(1):11-11.
[8] 易祥华,张容轩,高文,等.临床酷似肺癌的肺隐球菌病12例临床病理分析[J].诊断病理学杂志,2001,8(6):330-333.
[9] Xie X,Xu B,Yu C,et al.Clinical analysis of pulmonary cryptococcosis in non-HIV patients in south China[J].International journal of clinical and experimental medicine,2015,8(3):3114-3119.
[10] Zinck SE,Leung AN,Frost M,et al.Pulmonary cryptococcosis:CT and pathologic findings[J].Journal of computer assisted tomography,2002,26(3):330-334.
[11] 赵宇,蔡绍曦,汪金林,等.90例人类免疫缺陷病毒阴性宿主原发性肺隐球菌病的诊断分析[J].中国呼吸与危重监护杂志,2012,11(6):541-544.
[12] 吴俊. 肺隐球菌病(PC)肺部CT增强扫描影像表现及临床病理分析[J].中国CT和MRI杂志,2016,14(1):59-61.
[13] 兰长青,黄进宝,黄梅萍,等.结节肿块型肺隐球菌病CT特征分析[J].胸部放射学,2015,49(10):741-744.
[14] Li J,Chen Z.Pathological basis of air bronchogram examined by endobronchial ultrasound in patients with peripheral lung cancer[J].Chinese journal of lung cancer,2010,13(5):424-431.
[15] Pereira G H,Almeida L Y,Okubo R S,et al.Pulmonary histoplasmosis presenting with a halo sign on CT in an immunocompetent patient[J].Jornal Brasileiro de Pneumologia,2013,39(4):523-524.
[16] 易祥华,孔洁,朱美芳,等.原发性肺隐球菌病的病理诊断和超微结构观察[J].中华病理学杂志,2004,33(5):424-428.
[17] 苏毅,王乐乐,倪傲,等.螺旋CT扫描对周围型肺癌的诊断价值[J].临床肺科杂志,2012,17(5):897-899.
[18] 武建民. 局灶性机化性肺炎临床诊断中螺旋CT的应用价值及与周围型肺癌的鉴别[J].中国CT和MRI杂志,2015,13(6):25-28.
[19] 罗军,纪祥,张柏林,等.动态CT增强技术在孤立性肺结节中的诊断价值[J].现代中西医结合杂志,2015,24(31):3429-3431.
[20] 秦乃姗,唐光健,蒋学样.胸部增强CT扫描鉴别诊断肺内孤立性结节的研究[J].实用放射学,2001,17(4):244-246.
[21] 樊庆胜,李继亮,崔国强,等.球形肺炎的CT诊断与鉴别诊断[J].临床放射学杂志,2007,26(2):144-147.
[22] 刘欣欣,凌春华,黄振,等.54例肺炎性假瘤临床分析[J].浙江临床医学,2014,16(4):527-529.
[23] 张福康,冯仕庭,陈境弟,等.肺结核球和炎性假瘤CT动态增强扫描的表现[J].中国CT和MRI杂志,2011,9(2):32-34.