过敏性肺炎的影像学表现分析

过敏性肺炎（hypersensitivity pneumonitis），是指吸入各种具有抗原性的有机粉尘微粒物引起的一组肺部过敏性肉芽肿疾病。现收集我院2004年、2006年的10例过敏性肺炎的X线照片及CT扫描结果并结合有关文献分析如下。     

球形肺炎的CT表现

目的 :探讨球形肺炎的 CT表现及其鉴别诊断。方法 :选择 2 1例经临床或病理证实的球形肺炎及 2 1例经手术病理证实的周围型肺癌 ,将其 CT资料进行对比分析。结果 :球形肺炎与周围型肺癌 CT表现有明显不同。结论 :CT检查是鉴别球形肺炎与周围型肺癌的有效手段     

肾移植后巨细胞病毒肺炎的X线和CT表现

目的: 提高X线胸片和CT诊断肾移植后巨细胞病毒(CMV)肺炎的水平.材料和方法: 回顾性分析11例肾移植后CMV患者的X线胸片和CT表现.结果: 肾移植后CMV肺炎8例X线胸片表现为磨玻璃影和实变影,3例胸片正常;CT表现为双肺弥漫性病变,磨玻璃影最为常见,并与其它影像学表现合并存在,主要与实变影和多发性小结节样影合并存在;磨玻璃影在所有患者均表现为两侧肺分布.10例患者有多发性小结节样影;8例患者有多发实变影;5例并发有少量胸腔积液和小叶间隔增厚.结论: 肾移植后CMV肺炎的CT表现有一定特点,结合临床可提示诊断.     

成人肺炎支原体肺炎的CT表现

目的 认识成人肺炎支原体肺炎的CT及高分辨率CT（HRCT）表现。方法 16例经血清学检查证实的成人肺炎支原体肺炎,平均年龄41岁。回顾分析了所有病例的胸部常规CT及HRCT。结果 最常见的CT表现为磨玻璃样影12例,其中9例呈斑片状小叶分布;8例表现为气腔实变;9例可见“树芽征”;其他表现有小叶间隔增厚3例,支气管血管束增粗1例管。15例同时出现2种以上CT表现。结论 成人肺炎支原体肺炎的CT表现具有一定的特征性,有利于与细菌的肺炎区别。     

艾滋病合并肺孢子菌肺炎的64排CT表现特征

目的探讨艾滋病合并肺孢子菌肺炎的64排CT表现特征。方法对已确诊的8例艾滋病合并肺孢子菌肺炎的64排CT表现进行回顾性分析。结果肺孢子菌肺炎CT表现特征:1)磨玻璃征8例;2)铺路石征6例;3)肺气囊征4例;4)支气管血管束长索条征3例;5)月牙征2例。结论艾滋病患者出现上述典型CT表现特征应首先考虑合并肺孢子菌肺炎。     

球形肺炎的CT诊断

目的：探讨球形肺炎的CT表现及其鉴别诊断。方法：收集经临床证实的17例球形肺炎的CT资料进行回顾分析。结果：球形肺炎与周围型肺癌的CT表现有明显的不同。结论：CT检查对球形肺炎的诊断和鉴别诊断很有价值。     

外源性过敏性肺泡炎的HRCT诊断价值

目的 :评价高分辨率 CT(HRCT)对外源性过敏性肺泡炎的诊断价值。方法 :回顾性分析经纤维支气管镜检查和肺泡灌洗术证实的 16例外源性过敏性肺泡炎的 HRCT表现 ,急性期 2例 ,亚急性期 10例 ,慢性期 4例。结果 :外源性过敏性肺泡炎HRCT主要表现为 :微结节和 /或结节 ,气腔实变 ,磨玻璃样变 ,小叶间隔增厚及蜂窝状改变。发病的不同时期其主要改变各异。结论 :HRCT是诊断外源性过敏性肺泡炎最有价值的无创性检查 ,根据本病的 HRCT特征 ,结合临床病史 ,可不依赖支气管镜或肺活检而明确诊断     

肺气肿并发肺炎的高分辨率CT表现

肺气肿并发肺炎与单纯肺炎的临床和X线表现不同。CT广泛应用于临床后发现,肺气肿并发肺炎的CT和高分辨率CT(HRCT)表现不同于单纯肺炎,本文对一组肺气肿并发肺炎和单纯肺炎病人的CT和HRCT表现进行对比分析,旨在提高对肺气肿并发肺炎的HRCT征象的认识。1资料与方法1.1一般资料临床确诊为肺气肿并发肺炎病人21例,男15例,女6例;年龄41-79岁,平均63.5岁。肺气肿的诊断均符合慢性阻塞性肺疾病诊治规范[1]标准,HRCT上分为小叶中心型、全小叶型和间隔旁型3种亚型。肺炎根据临床症状、体征、影像学表现和实验室检查确诊。除外并发支气管扩…     

肺炎性假瘤的CT诊断与鉴别诊断(附11例报告)

目的:分析肺炎性假瘤的CT表现,以便与周围型肺癌及结核球等球形病灶鉴别.方法:收集11例经病理证实的肺炎性假瘤的CT及临床资料进行回顾分析.结果:病灶多位于肺边缘部胸膜下,多呈圆形或类圆形,边缘模糊,直径2～4 cm,密度均匀,边缘可见粗长毛刺、尖角状突起,可有纵隔淋巴结肿大.结论:全面分析肺炎性假瘤的CT表现,重视肺部感染史,对本病的诊断和鉴别诊断很有帮助.     

CT和B超在诊断腹型过敏性紫癜中的临床应用

目的 探讨急诊CT和B超在诊断腹型过敏性紫癜中的临床应用.方法 回顾性分析本院25例临床诊断为腹型过敏性紫癜病人的腹部CT和B超(23例)表现.年龄4～76岁不等,男16例,女9例,所有病例均以急性腹痛表现入院,腹痛前均有皮肤出血斑,21例儿童病例有血便史.结果 CT和B超表现为单节段或多节段肠壁水肿增厚、肠腔狭窄、肠系膜淋巴结肿大、肠系膜水肿及腹水.结论 CT和B超检查对腹型过敏性紫癜的诊断有较大的帮助.     

Hypersensitivity pneumonitis.

Hypersensitivity pneumonitis is an immunologic mediated response in the lung to inhaled organic antigen. Farmer's lung and pigeon breeder's lung are the two most widely know disorders. The chest radiograph usually is normal in hypersensitivity pneumonitis. When abnormal, the distribution of disease favors the lung bases with acute disease and the upper lung zones with chronic disease. Computed tomography (CT) may be more sensitive in detecting parenchymal abnormalities, although the characteristic findings of hypersensitivity pneumonitis at CT or high-resolution CT are nonspecific.     

Hypersensitivity pneumonitis: patterns on high-resolution CT

Hypersensitivity pneumonitis, also known as extrinsic allergic alveolitis, is caused by inhalation of specific environmental organic antigens. This disease may have typical high-resolution CT findings that, in the appropriate clinical setting, can be sufficiently characteristic to allow a confident diagnosis without the need for a lung biopsy. In this pictorial essay, the high-resolution CT patterns of hypersensitivity pneumonitis are illustrated. The authors emphasize the correlation among the radiologic presentation, functional abnormalities, and pathologic findings.     

Hypersensitivity pneumonitis: sensitivity of high-resolution CT in a population-based study.

OBJECTIVE. Hypersensitivity pneumonitis refers to a group of pulmonary disorders caused by inhalation of organic or inorganic particulates by sensitized persons. The diagnosis relies on a constellation of findings: exposure to an offending antigen, characteristic signs and symptoms, abnormal chest findings on physical examination, and abnormalities on pulmonary function tests and radiographic evaluation. In population-based studies, the sensitivity of chest radiography for detection of this disease is relatively low. The aim of this study was to determine the sensitivity of high-resolution CT (HRCT) for detection of hypersensitivity pneumonitis diagnosed in a population of swimming-pool employees. SUBJECTS AND METHODS. Thirty-one symptomatic employees of a recreation center who were referred because of possible hypersensitivity pneumonitis were examined by using chest radiography, HRCT, and fiberoptic bronchoscopy with bronchoalveolar lavage and transbronchial biopsy. Hypersensitivity pneumonitis was diagnosed in subjects who had two or more work-related signs or symptoms, abnormal results on transbronchial biopsies, and abnormal lymphocytosis as shown by examination of bronchoalveolar lavage fluid. The chest radiographs and HRCT scans were interpreted by consensus by two observers who were unaware of the clinical diagnosis. RESULTS. Only one of 11 subjects with a diagnosis of hypersensitivity pneumonitis had abnormal findings on a chest radiograph. Five had abnormal HRCT findings. The abnormality in each case consisted of small, poorly defined centrilobular nodules with variable profusion. No subject without the disease had abnormal HRCT findings. Those who had granulomas shown by lung biopsy were more likely to have abnormal HRCT findings than were those who had more subtle histologic abnormalities. CONCLUSION. The sensitivity of HRCT for the detection of hypersensitivity pneumonitis in a population-based study is greater than that of chest radiography. The finding of poorly defined centrilobular nodules on HRCT scans should prompt consideration of this disease.     

Chronic hypersensitivity pneumonitis: use of CT in diagnosis.

OBJECTIVE. In its subacute or chronic form, hypersensitivity pneumonitis is often difficult to distinguish clinically and physiologically from other idiopathic diffuse lung diseases. The aim of this study was to identify high-resolution CT features that allow distinction of chronic hypersensitivity pneumonitis from other chronic diffuse parenchymal lung diseases. MATERIALS AND METHODS. Six patients with chronic hypersensitivity pneumonitis were examined with pulmonary function testing, bronchoalveolar lavage, lung biopsy, chest radiography, and high-resolution CT. The chest radiographs and high-resolution CT scans were reviewed independently by three observers without knowledge of the patients' clinical status. Discrepancies between the observers were resolved by consensus. RESULTS. The chest radiographs revealed normal lung volumes with a combination of abnormalities: a mixed alveolar/interstitial pattern in five cases, peribronchiolar thickening in three, a diffuse granular pattern in one, and a linear fibrotic pattern in one. In general, the high-resolution CT scans showed more abnormalities than were apparent on the plain chest radiographs. High-resolution CT revealed centrilobular, peribronchiolar, indistinct nodular opacities, of various numbers, in all cases. Four cases had areas of ground-glass density, three cases had lobular areas of hyperlucency, and one case had areas of pulmonary fibrosis and honeycombing. CONCLUSION. We confirm that high-resolution CT can most clearly show the type and distribution of parenchymal abnormalities in patients with hypersensitivity pneumonitis. Importantly, although not pathognomonic, the high-resolution CT finding of centrilobular, peribronchiolar, indistinct nodules should suggest the diagnosis of chronic hypersensitivity pneumonitis.     

Lung cysts in subacute hypersensitivity pneumonitis

PURPOSE: To determine the frequency of cystic lesions on high-resolution computed tomography (CT) in patients with subacute hypersensitivity pneumonitis. METHODS: High-resolution CT scans in 182 patients with proven subacute hypersensitivity pneumonitis were retrospectively evaluated for the presence of lung cysts. Patients with CT evidence of emphysema or interstitial fibrosis and patients with connective tissue disease were excluded from the study. Two thoracic radiologists reviewed the thoracic CT scans for the presence and location of lung cysts. RESULTS: Thin-walled lung cysts were identified in 24 (13%) of 182 patients and ranged in size from 3 to 25 mm in maximal diameter. The patients included 16 men and 8 women (age range, 30-79 years; mean age, 48 years). The cysts ranged from 1 to 15 in number (mean, 4 cysts) and had a random distribution. Sixteen of the 24 patients also had areas of decreased attenuation and vascularity consistent with air trapping. CONCLUSIONS: Thin-walled cysts can be seen in a small percentage of patients with subacute hypersensitivity pneumonitis. The cysts resemble those seen in lymphocytic interstitial pneumonia, and their pathogenesis is uncertain.     

Summer-type hypersensitivity pneumonitis: comparison of high-resolution CT and plain radiographic findings.

Summer-type hypersensitivity pneumonitis is an immunologic disease that occurs only in Japan. It is a form of hypersensitivity pneumonitis in which the clinical symptoms appear in the summer and subside spontaneously in mid autumn. The purpose of our study was to determine the CT findings in this condition, to compare the CT findings with those on chest radiographs, and to assess the variations in the CT findings over time. Accordingly, high-resolution CT scans and chest radiographs of 15 patients with summer-type hypersensitivity pneumonitis were retrospectively studied. Seven patients had sequential CT examinations 18-37 days apart. The CT scans and chest radiographs were reviewed by two observers independently. CT findings included diffuse micronodules (n = 15), slightly elevated lung density (n = 13), and patchy air-space consolidation (n = 13). In one patient, the findings on a chest radiograph were normal, while CT showed parenchymal abnormalities. In two cases, follow-up CT showed micronodular abnormalities after findings on the chest radiograph had returned to normal. Our results show that high-resolution CT findings of summer-type hypersensitivity pneumonitis include pulmonary micronodules, increased lung density, and air-space consolidation. High-resolution CT appears to be more useful than plain chest radiographs in the evaluation of pulmonary parenchymal abnormalities in this condition.     

亚急性或慢性过敏性肺泡炎的高分辨率CT影像特征

目的：分析亚急性或慢性过敏性肺泡炎高分辨率 CT(HRCT)的影像特征，以期进一步提高其HRCT诊断的准确性。方法：21例亚急性或慢性过敏性肺泡炎患者行肺功能、支气管肺泡灌洗、经支气管镜肺活检、胸部X线平片和HRCT.结果：HRCT图像上16例表现出数量不等的边界模糊的小叶中心结节，13例可见磨玻璃样密度，4例有密度减低区，5例显示局限性的空气残留（airtrapping）并形成“马赛克”样灌注，2例出现散在的小叶中心性气肿、2例发生肺纤维化。结论；HRCT可以清晰显示过敏性肺泡炎病变的类型及分布。HRCT图像上表现为弥漫性边界模糊的小叶中心性结节或小叶中心结节与磨玻璃样祺及密度减低区同时存在时，应考虑亚急性或慢性过敏性肺泡炎的诊断。     

Hypersensitivity pneumonitis: evaluation with CT

Thirteen chest radiographs and computed tomographic (CT) scans obtained from 11 patients with hypersensitivity pneumonitis were reviewed. The CT findings were correlated with open lung biopsy findings in seven patients. The two patients with acute hypersensitivity pneumonitis showed air-space opacification on CT scans. An open lung biopsy, done in one of these patients, demonstrated noncaseating granulomas and filling of the air spaces with macrophages. The nine patients with subacute hypersensitivity pneumonitis showed small, rounded opacities and patchy air-space opacification on CT scans. These findings reflected the histologic findings, which consisted of interstitial pneumonitis, cellular bronchiolitis, and small, noncaseating granulomas. The six patients with symptoms for 12 months or longer also showed irregular linear opacities on CT scans, corresponding to areas of fibrosis. CT scans were superior to radiographs in helping to assess the type and extent of abnormalities, and high-resolution CT scans were superior to conventional CT scans.     

High-resolution computed tomography of Japanese summer-type hypersensitivity pneumonitis

The high-resolution computed tomographic (CT) manifestations of Japanese summer-type hypersensitivity pneumonitis in eight patients were correlated with those of their chest radiography and with their histological findings. Histologically proven small granulomas were clearly demonstrated on CT as miliary opacities in five patients whose chest radiographic findings were normal. In two patients, these abnormalities were observed both by CT and chest radiography. High-resolution CT provides detailed morphological information about the lung parenchyma; it is an excellent means of following the clinical courses of hypersensitivity pneumonitis. CT is particularly useful for detecting persistent granulomas when symptoms subside and chest radiography becomes normal or nearly so.     

Hypersensitivity pneumonitis: spectrum of high-resolution CT and pathologic findings

OBJECTIVE: The purpose of this article is to illustrate the spectrum of pathologic and high-resolution CT features of hypersensitivity pneumonitis (HP). CONCLUSION: High-resolution CT plays an important role in the diagnosis of HP. A confident diagnosis of subacute HP is based on the presence of ground-glass opacities, poorly defined centrilobular nodules, and mosaic attenuation on inspiratory images and of air trapping on expiratory CT images. Chronic HP is characterized on high-resolution CT by the presence of reticulation due to fibrosis superimposed on findings of subacute HP. Histologically, subacute HP is characterized by the presence of cellular bronchiolitis, noncaseating granulomas, and bronchiolocentric lymphocytic interstitial pneumonitis. Areas of organizing pneumonia also may be seen. The high-resolution CT and pathologic features of chronic HP frequently overlap with those of nonspecific interstitial pneumonia and usual interstitial pneumonia. Awareness of the various manifestations of HP is important for early diagnosis and management.