摘要
目的探讨免疫功能无异常的原发性肺隐球菌病患者 CT 征象及 CT 引导下经皮肺穿刺活检在诊断中的价值。方法回顾性分析浙江大学医学院附属邵逸夫医院经病理证实的12例原发性肺隐球菌病患者的临床资料。结果 (1)12例患者的 CT 征象均为单肺叶发病,其中单发结节4例,局限性多发混杂的结节和(或)肿块和(或)肺实变8例,此外还可见支气管充气征/小泡征(9例)、空洞(2例)和“晕”征(4例)。(2)9例行 CT 引导下经皮肺穿刺活检,其中7例病理学确诊。(3)12例患者中7例行手术切除,术后2例行氟康唑治疗,余5例未用药,其中1例术后5个月发生隐球菌性脑膜炎;另5例用氟康唑治疗。结论免疫功能无异常者时有发生肺隐球菌病的可能;肺隐球菌病的临床症状与影像学表现明显不相称;大多数肺隐球菌病的 CT 主要征象为局限性多发混杂的结节和(或)肿块和(或)肺实变,如同时有支气管充气征/小泡征、晕征,则具有特征性;尽早采用CT 引导下经皮穿刺活检将有助于该病的早期诊断;氟康唑治疗该病效果好,有助于预防严重并发症的发生。
Objective The purpose of this study was to analyze the chest CT findings of immunocompetent patients with primary pulmonary eryptococcosis and to evaluate the utility of CT-guided percutanous biopsy in the diagnosis. Methods Chest CT scans of 12 immunocompetent patients with biopsy-proven primary pulmonary cryptocococsis were analyzed for the number of lesions, morphologic characteristics, distribution of parenchymal abnormalities, and the presence of lymphadenopathy and pleural effusion. Lung specimens were obtained by CT guided percutaneous biopsy （n =9） and/or surgical resection （ n = 7 ）. A pulmonary pathologist reviewed the specimens. Restults The main manifestations were classified into two patterns. Localized multiple mixed lesions （ nodules and/or masses and/or consolidation ） were found in 67% （8/12） of the cases, and single nodules were found in 33% （4/12）. Associated findings included air bronchograms （n =9）, cavity（n =2）, and CT halo sign（n =4）. Lung specimens were obtained by CT guided percutaneous biopsy in 9 cases, of which 7 （78%） were confirmed by pathology. Seven cases recovered after treatment with fluconazole, but cryptococcal meningitis occurred in 1 case 5 month after single excision. Conclusions Chest CT findings of primary pulmonary cryptococcosis in immunocompetent patients have a predominant pattern of localized multiple mixed lesions. CT guided percutaneous biopsy is helpful in confirming the diagnosis. Fluconazole is effective in the treatment of pulmonary cryptococcosis in these patients.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2006年第9期721-724,共4页
Chinese Journal of Internal Medicine
