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1.
目的探讨造血干细胞移植术(HSCT)后肺部感染性并发症特征性的CT表现及诊断价值。方法回顾性分析70例HSCT后伴肺部感染性并发症患者的临床、实验室以及肺部CT检查及治疗后复查资料。结果 70例中56例获得明确的病原学诊断,病毒感染31例(31/56,55.4%),巨细胞病毒感染最常见(18/31,58.1%),支原体及细菌感染19例(19/56,33.9%),真菌感染6例(6/56,10.7%)。病毒性肺炎表现为多发或弥漫性磨玻璃影(GGO),多发小片状实变,多发结节、线状、网状影,以GGO最多见。细菌性及支原体肺炎主要表现为单发或多发片状实变及磨玻璃影。真菌性肺炎主要是肺曲霉菌病(IPA),主要表现为伴或不伴晕征的多发结节和空洞性病变,空气新月征是典型征象。移植后1~5月发生率最高的为巨细胞病毒性肺炎,6个月后真菌感染增多。结论综合分析CT表现结合术后时间及临床实验室资料,有助于提高造血干细胞移植后肺部感染诊断的准确性。  相似文献   

2.
目的:探讨肾移植术后肺巨细胞病毒感染的CT特点。方法:回顾性分析24例经临床及实验室检查证实的巨细胞病毒感染(CMV)的CT特征。结果:本组24例巨细胞病毒感染患者中有2例CT表现未见明显异常,其余22例均有毛玻璃样阴影改变,其中呈两肺多发、散在分布7例,呈两肺弥漫性分布15例。仅表现为毛玻璃影者4例,伴有小叶间隔增厚10例,伴有实变影者7例,伴有多发小结节影者8例,伴有少量胸腔积液者4例。结论:肾移植术后肺巨细胞病毒感染最常见CT表现为双肺弥漫性分布的毛玻璃样阴影,且常伴有小叶间隔增厚、小结节影、实变影等表现。  相似文献   

3.
目的:探讨白血病骨髓移植术后巨细胞病毒性肺炎的高分辨率CT表现。材料和方法:收集接受高分辨率CT扫描的17例巨细胞病毒性肺炎患者,对其CT表现进行回顾性分析,CT表现包括病变形态、病变分布、淋巴结肿大、胸腔积液等。结果:骨髓移植术后3周内发生者3例,3~14周内发生者12例,14周后发生者2例。中心肺野和周围肺野同时都有者10例。所有病例均双侧分布,其中对称分布3例,不对称分布14例。磨玻璃密度7例,实变影4例,网状改变2例,树芽征1例;多发结节性病灶3例。3例出现淋巴结肿大,3例病人出现胸腔积液。结论:骨髓移植术后巨细胞病毒性肺炎没有特征性CT征象,多表现为双侧不对称分布的混合性病变,综合分析病变形态、分布以及移植术后出现时间有助于与其他并发症鉴别。  相似文献   

4.
目的 探讨肝移植术后巨细胞病毒(CMV)肺炎的高分辨率CT(HRCT)表现,提高对其认识水平.方法 回顾性分析11例肝移植术后CMV肺炎的HRCT表现.结果 毛玻璃影10例,多发结节8例,斑片状实变影4例.所有病例见到多种形态病灶共同存在:毛玻璃影与多发结节4例,毛玻璃影与实变影3例,实变影与多发结节1例,毛玻璃影、实变影与多发结节三者共同存在3例.所有病变均累及双肺,9例病灶分布于肺内外带,仅分布于外带和内带各3例.病变累及下叶11例,累及中叶与上叶分别为10例、9例.4例胸膜增厚,3例少量胸腔积液和1例少量心包积液.所有病例均未见到肺门及纵隔肿大淋巴结.结论 肝移植术后CMV肺炎的HRCT表现主要为双肺混合存在的毛玻璃影、多发结节及斑片实变影,这些征象可作为诊断肝移植术后CMV肺炎的重要依据.  相似文献   

5.
肝移植术后肺部感染的CT表现   总被引:2,自引:0,他引:2  
目的 提高对肝移植术后肺部感染CT表现的认识,以提高诊断准确率.方法 回顾性分析45例肝移植术后肺部感染病例的CT资料.结果 CT主要表现为实变影32例,以右下肺或双下肺分布多见;磨玻璃影22例,双肺弥漫性分布多见;结节影10例,均为多发、双肺分布,直径均<3 cm(其中直径<1 cm者7例),包括两肺弥漫性粟粒样结节3例;网格样影或线样影4例,分布于两肺上叶2例,广泛分布于两肺各叶2例.不同感染类型表现,细菌感染以实变影最常见,其次为磨玻璃影;真菌感染实变影、磨玻璃影、结节影均较常见.结论 CT对于肝移植术后肺部感染的诊断具有重要价值.  相似文献   

6.
目的 探讨肺移植术后并发症的多层螺旋CT(MSCT)表现.方法 18例终末期肺病患者接受单肺或双肺移植,肺移植术后常规胸部MSCT平扫后,再对扫描图像进行薄层重建及多平面重建(MPR),观察移植肺实质变化的细微结构和支气管并发症等.结果 18例患者中,移植肺再灌注水肿7例,CT表现为毛玻璃片样影及胸腔积液、局限性肺实变.急性排斥反应5例,CT表现为毛玻璃片样影、小叶间隔增厚、支气管扩张伴管壁增厚、胸腔积液.慢性排斥反应1例,CT表现为毛玻璃片样影,支气管或细支气管扩张伴管壁增厚、小叶间隔增厚、胸腔积液.吻合口狭窄5例.所有患者移植后肺部均出现不同程度的感染.结论 MSCT肺部薄层重建图像可清楚显示终末期肺病肺移植术后并发症的肺内改变并准确对其评估;MSCT可作为肺移植术后定期随访复查的重要检查工具.  相似文献   

7.
目的:分析免疫功能低下患者肺部感染的CT表现及鉴别诊断。方法:回顾性分析尿毒症长期血透治疗患者和肾移植术后致免疫功能低下肺部感染患者87例,分析比较CT上不同病原体的肺部感染病灶的形态、分布、密度等特征和动态变化的规律。并与病原学诊断结果对照。结果:本组87例肺部感染患者中,细菌性肺炎37例(42.53%),巨细胞病毒性肺炎14例(16.09%),卡氏肺囊虫肺炎6例(6.89%),肺结核19例(21.84%),真菌性肺炎11例(12.64%)。CT表现为弥漫性斑片状和磨玻璃样伴点状或网状阴影共20例;表现为小片状或大片状阴影41例;其他表现为散在小结节、斑片状或条状不规则阴影。结论:本组病例中以细菌性肺炎最多见,其次为肺结核。免疫功能低下患者不同肺部感染的CT表现有一定特点,巨细胞病毒性肺炎和卡氏肺囊虫肺炎主要表现为伴有肺间质增厚;细菌性肺炎和真菌性肺炎主要表现为肺实质渗出性病变;肺结核主要表现为不均匀粟粒影。CT对鉴别诊断有一定价值。  相似文献   

8.
目的:探讨造血干细胞移植(HSCT)术后肺部感染的多层螺旋 CT(MSCT)表现。方法临床证实的 HSCT 术后肺部感染192例患者,分析有完整胸部 CT 资料的69例各时期病原体种类及 CT 表现。结果(1)HSCT 术后肺部感染69例在术后早期(30 d 内)、中期(31~100 d)、后期(100 d 以后)3个时间段的构成比分别为55.1%、24.6%、20.3%。细菌、真菌及混合感染多发生于早期,分别占78.6%、52.6%、56.7%;病毒感染多发生在中期,占66.7%;后期细菌、真菌、病毒及混合感染分别占14.3%、10.6%、33.3%、26.7%。(2)CT 特征:细菌感染以实变影(7/14)及磨玻璃影(6/14)最常见;真菌感染以结节或肿块(15/19)最常见;病毒感染以磨玻璃影(3/6)最常见;结核均为混合感染,以结节(3/5)及多发实变影(2/5)常见;混合感染以磨玻璃影(15/30)及结节或肿块影(15/30)最为常见。在各病原体感染中除真菌感染出现征象的差异具有统计学意义(P <0.05)外,其他无统计学意义(P >0.05)。结论HSCT 术后肺部感染高峰为术后早期;细菌、真菌及混合感染多发生于早期;CT 对于 HSCT 术后肺部感染的诊断具有重要价值。  相似文献   

9.
目的 探讨人类获得性免疫缺陷综合征(AIDS)合并症的影像与病理表现特点.方法 回顾性分析8例AIDS尸体的解剖资料及影像、病理资料.对其不同的部位进行常规CT扫描和(或)MR检查;7具尸体在冷冻状态下行横断断层解剖观察,1具行大体解剖;在各断层面和各脏器取材行病理检查,对比分析受累脏器影像改变以及其病理改变基础,从病理结果中作出病因学诊断.结果 8例AIDS患者中,寄生虫感染5例、细菌感染3例(2例结核菌感染,1例肺炎球菌肺炎)、真菌感染2例、病毒感染2例、B细胞性淋巴瘤1例、1例巨细胞病毒(CMV)感染患者同时合并脑大面积梗死.5例肺部卡氏肺孢子虫肺炎(PCP)感染者CT表现为以肺门为中心的对称性毛玻璃状阴影;2例肺部结核CT表现为肺部片状阴影、散在分布的结节影及弥漫粟粒性均匀分布的结节影和结核性胸膜炎;2例真菌感染CT表现为云雾状模糊密度阴影及多灶性慢性炎症表现;曲霉菌典型表现为曲霉菌肿.2例肺部CMV感染表现为肺部网格状及实变影.1例肠道肿瘤CT表现为肠管壁增厚,管腔狭窄.1例CMV脑炎CT表现为脑组织低密度影,及MR表现为长T_1、长T_2信号,MRA显示脑组织液化区血管中断.1例脑弓形虫感染CT表现左侧内囊部位可见片状低密度区.1例脑部隐球菌感染CT表现大脑基底节区多发小片状低密度区.结论 AIDS患者可同时或先后合并多个器官多种病原体感染或肿瘤发生,影像表现多样化,无明显特异性,鉴别诊断困难,病理表现更复杂.影像表现与病理结合有助于明确诊断.  相似文献   

10.
目的 分析异基因造血干细胞移植后慢性期肺部病变的CT表现及治疗后变化的影像特点.资料与方法 对近4年行异基因造血干细胞移植后生存期超过3个月的受者中发现胸部异常的35例患者的CT影像资料进行回顾性分析.结果 移植后慢性期胸部CT表现:9例旱局限叶或多叶的磨玻璃样改变,同时伴网状或网织结节状影;16例为散在胸膜下肺内团片状或斑点状影.伴支气管气像5例;5例表现为胸膜下肺内多发球形不均匀密度影与厚壁空洞并存;4例表现为下肺间质条索状密度影;1例为肺气囊.治疗过程中累计出现19个空洞,2例纵隔气肿.2例气胸,治疗时间约2~6个月.结论 异基因造血干细胞移植后慢性期肺部病变以肺间质病变为主,实变病灶好发于胸膜下且易合并真菌感染出现空洞,上肺较下肺好发.  相似文献   

11.
OBJECTIVE: The aim of this study was to describe the high-resolution CT findings of respiratory syncytial virus pneumonia in 20 patients who had undergone allogeneic bone marrow transplantation. MATERIALS AND METHODS: The study included 20 consecutive patients who developed respiratory syncytial virus pneumonia after bone marrow transplantation and who had high-resolution CT of the chest performed within 24 hr after the onset of symptoms. The CT scans were reviewed by two chest radiologists who assessed the pattern and distribution of findings. RESULTS: Bone marrow transplantation was performed on 12 male and eight female patients ranging from 3 to 48 years old (mean age, 25 years) for treatment of various forms of leukemia (n = 12), severe aplastic anemia (n = 6), Fanconi's syndrome (n = 1), and paroxysmal nocturnal hemoglobinuria (n = 1). Sixteen patients (80%) had abnormal CT findings. The predominant patterns of abnormality on high-resolution CT scans were small centrilobular nodules (10/20, 50%), air-space consolidation (7/20, 35%), ground-glass opacities (6/20, 30%), and bronchial wall thickening (6/20, 30%). The abnormalities were distributed in the central and peripheral areas of the lungs in nine cases, only in the periphery in five cases, and only in the central regions in two cases. The abnormalities were bilateral and asymmetric in distribution in 13 patients, bilateral and symmetric in two patients, and unilateral in one patient. CONCLUSION: The most common high-resolution CT findings in patients with respiratory syncytial virus pneumonia after bone marrow transplantation consist of small centrilobular nodules and multifocal areas of consolidation and ground-glass opacities in a bilateral asymmetric distribution.  相似文献   

12.
重症及危重症甲型H1N1流感肺炎的影像表现   总被引:5,自引:0,他引:5  
目的 探讨重症及危重症甲型H1N1流感病毒肺部感染的胸部影像表现.方法 回顾性分析18例甲型H1N1流感并发肺炎患者的临床及影像资料,将其分为重症组(11例)及危重症组(7例),所有患者均经胸部X线检查,其中2例行CT检查.结果 重症组11例,8例X线表现为双侧肺野中内带分布的、边缘模糊的小斑片和结节状阴影,3例X线表现为局灶性边缘模糊的片状阴影,其中1例胸部CT表现为右下肺大片实变影.危重症组7例,4例X线表现为双肺弥漫分布的磨玻璃密度阴影伴部分实变,其中1例出现胸颈部皮下气肿,1例胸部CT表现为双肺广泛分布的、沿支气管走行的斑片状磨玻璃密度影,双下肺结节状实变病灶和胸腔积液;其他3例表现为双侧肺野内大范围实变影.结论 甲型H1N1流感肺炎的影像表现包括重症患者肺内的结节样和斑片状阴影,危重患者肺内弥漫的支气管周围分布的磨玻璃密度灶和多灶性实变.  相似文献   

13.
OBJECTIVE: To assess the high-resolution computed tomography (HRCT) appearances of bronchiolitis obliterans organizing pneumonia (BOOP) after bone marrow transplantation (BMT). METHODS: The HRCT scans obtained in 4 patients (2 men and 2 women, age range: 20-50 years, mean age = 36 years) with biopsy-proven BOOP after BMT were reviewed retrospectively by 2 observers for the presence, extent, and distribution of parenchymal abnormalities. RESULTS: All patients demonstrated consolidation and ground-glass opacity. The consolidation was bilateral, patchy, and asymmetric in all patients and was predominantly peribronchovascular in 3 patients and subpleural and peribronchovascular in 1 patient. Ground-glass opacity was patchy and asymmetric in all patients and was bilateral in 3 patients and unilateral in 1 patient. No zonal predominance of either feature could be identified. CONCLUSIONS: The predominant HRCT features of BOOP after BMT are bilateral, patchy, and asymmetric consolidation in a predominantly peribronchovascular distribution with associated ground-glass opacity.  相似文献   

14.
闭塞性细支气管炎伴机化性肺炎的高分辨CT表现   总被引:1,自引:0,他引:1  
目的探讨闭塞性细支气管炎伴机化性肺炎的高分辨CT表现,并与慢性嗜酸性肺炎和寻常型间质性肺炎进行鉴别。方法结合相关文献回顾性分析12例闭塞性细支气管炎伴机化性肺炎高分辨CT表现。结果12例闭塞性细支气管炎伴机化性肺炎的高分辨CT表现如下:(1)肺内多发斑片状肺实变影和磨玻璃影(n=8),其中肺实变影中见支气管充气征(n=5)。(2)肺内多发小结节影和不规则线状影(n=7)。(3)肺内多发斑片状肺实变影和磨玻璃影伴小结节影和不规则线状影(n=3)。(4)细支气管扩张、壁增厚伴周围肺实变影(n=6)。(5)肺内肺实变影和磨玻璃影呈游走性(n=3)。结论高分辨CT可以更好地显示闭塞性细支气管炎伴机化性肺炎的病理改变,并使其能与慢性嗜酸性肺炎和寻常型间质性肺炎在影像上进行鉴别,也为纤维支气管镜下肺活检提供准确的定位。  相似文献   

15.
CT findings of pneumonia after lung transplantation   总被引:6,自引:0,他引:6  
OBJECTIVE: The purpose of this study was to describe the CT findings of pneumonia in patients who had undergone lung transplantation and to determine if specific imaging features existed for the different infectious organisms. MATERIALS AND METHODS: The authors retrospectively reviewed the medical records of 262 patients with transplanted lungs at two lung transplantation centers. Patients with a documented pneumonia and correlating abnormal findings on CT (39 patients with 45 pneumonias) were included in the study. RESULTS. Of 45 pneumonias, Cytomegalovirus (n = 15), Pseudomonas (n = 7), and Aspergillus (n = 8) organisms were the most common single responsible infectious agents. The most common CT findings of pneumonia consisted of consolidation (n = 37; 82%), ground-glass opacification (n = 34; 76%), septal thickening (n = 33; 73%), pleural effusion (n = 33; 73%), and multiple (n = 25; 56%) or single (n = 2; 4%) nodules. No significant difference in the prevalence of findings was revealed among bacterial, viral, and fungal pneumonias (p >.05, chisquare test). Of 25 pneumonias in patients with a single transplanted lung, parenchymal abnormalities involved both lungs in 12 (48%), only the transplanted lung in 11 (44%), and only the native lung in two (8%). CONCLUSION: The manifestations revealed on CT of bacterial, viral, and fungal pneumonia after lung transplantation are similar, consisting of a combination of consolidation, ground-glass opacification, septal thickening, pleural effusion, or multiple nodules. Therefore, these findings cannot be used to suggest the infectious organisms in this patient population.  相似文献   

16.
Bronchiolitis obliterans organizing pneumonia (BOOP) is a nonneoplastic, noninfectious lung disease with a diverse spectrum of imaging abnormalities and nonspecific symptoms diagnosed by open lung biopsy, transbroncial biopsy, and/or video-assisted thoracoscopy. The objective of this study was to retrospectively assess the role of percutaneous computed tomography (CT)-guided biopsy in early diagnosis of the disorder. Fourteen BOOP cases diagnosed by CT-guided biopsy were analyzed in terms of imaging abnormalities and complication rate. All had previously undergone a nondiagnostic procedure (bronchoscopy, transbronchial biopsy, bronchoalveolar lavage) to exclude infection or lung cancer. The most common imaging abnormalities in descending order were bilateral consolidations (5/14), unilateral tumor-like lesions (5/14), unilateral consolidations (3/14), and diffuse reticular pattern (1/14). Coexistent abnormalities (pleural effusions, nodules, ground-glass opacities) were observed in five patients. The complication rate was 4 of 14 (28.6%), including 2 cases of subclinical pneumothorax and 1 case of minor hemoptysis and local lung injury. None required intervention. We conclude that transthoracic CT-guided biopsy may be used in the diagnosis of BOOP in selected patients with mild complications. For the focal consolidation nodule/mass imaging pattern, CT-guided biopsy may prove to be a reasonable alternative to more invasive procedures.  相似文献   

17.
肾移植受者卡氏肺囊虫肺炎影像学研究   总被引:7,自引:0,他引:7  
目的 提高对肾移植受者并发卡氏肺囊虫肺炎(PCP)影像学特点的认识。方法 总结24例肾移植受者并发PCP的影像学表现,分析其治疗前后的动态变化。结果 男19例,女5例;平均年龄39.2岁。发病距肾移植时间平均5.6个月,起病至就诊时间平均5.5d,发热24例,呼吸困难24例。病理表现为肺泡内蛋白样物质渗出,肺泡上皮细胞变性,肺泡间隔增宽,局部可见纤维化样改变。就诊时胸部X线10例呈弥漫性改变,其中3例磨玻璃样改变,2例磨玻璃样改变中见网格样改变,4例伴有片状渗出或融合实变。就诊时24例胸部CT均可见磨玻璃样改变,其中9例可见细网格状改变,12例可见边缘模糊的片状渗出影及肺内实变影。随着病情加重,胸部X片、CT出现肺内渗出和实变增多,明显时可见支气管空气影。约1—2周内发展到高峰。治疗有效后约1周,胸部X片及CT出现病变吸收好转的改变,1个月内基本吸收。结论 肾移植患者卡氏肺囊虫肺炎影像学表现为两肺弥漫性改变包括间质改变或肺泡渗出、实变,进展快,治疗有效后约1周胸部X片及CT才出现吸收好转的改变,1个月内基本吸收。胸部CT检查比X片更敏感。  相似文献   

18.
OBJECTIVE: The aim of our study was to evaluate the usefulness of the reversed halo sign on high-resolution CT in the diagnosis of cryptogenic organizing pneumonia. MATERIALS AND METHODS: Between 1996 and 2001, we saw 31 patients with biopsy-proven cryptogenic organizing pneumonia. During the same period, we also saw 30 patients with non-cryptogenic organizing pneumonia diseases, from which cryptogenic organizing pneumonia should be differentiated: Wegener's granulomatosis (n = 14), diffuse bronchioloalveolar carcinoma (n = 10), chronic eosinophilic pneumonia (n = 5), and Churg-Strauss syndrome (n = 1). Two independent observers analyzed CT findings and recorded how frequently the so-called reversed halo sign (central ground-glass opacity and surrounding air-space consolidation of crescentic and ring shape) was seen on high-resolution CT. RESULTS: The most common patterns of parenchymal abnormalities of cryptogenic organizing pneumonia were ground-glass opacity (28/31 patients, 90%) and consolidation (27/31, 87%). The ground-glass opacity pattern showed random distribution, and the consolidation pattern showed subpleural or peribronchovascular (20/27 patients, 74%) distribution with predominance in the middle or lower lung zone. The reversed CT halo sign was seen in six (19%) of 31 patients with cryptogenic organizing pneumonia and in none of the patients with the diseases that needed to be differentiated from cryptogenic organizing pneumonia on CT. CONCLUSION: The reversed halo sign, although seen only in one fifth of patients with the disease, appears relatively specific to make a diagnosis of cryptogenic organizing pneumonia on CT.  相似文献   

19.
OBJECTIVE: The aim of this study was to review the thin-section CT findings in 32 immunocompromised patients without AIDS who had proven Cytomegalovirus pneumonia. MATERIALS AND METHODS: The causes of immunocompromise included bone marrow (n = 25) or solid organ transplantation (n = 5) and corticosteroid therapy (n = 2). The patients included 16 men and 16 women ranging in age from 22 to 70 years (mean age, 43 years). The CT scans were retrospectively reviewed by two thoracic radiologists for the presence, appearance, and distribution of parenchymal abnormalities. RESULTS: Bilateral abnormalities were seen in all patients. Areas of ground-glass opacification were seen in 21 (66%) of 32 patients. Ground-glass opacification was the predominant CT feature in nine cases (28%). In 19 of 32 patients, ground-glass attenuation was associated with other abnormalities. Multiple nodules were identified in 19 patients (59%). Nodules were bilateral in 15 patients and unilateral in four patients. Nodules were the only CT finding in three patients (9%). Areas of air-space consolidation were identified in 19 patients (59%). Air-space consolidation was the only CT finding in one patient (3%). Other less common CT findings included thickening of the bronchovascular bundles (n = 7) and the tree-in-bud appearance (n = 4). Pleural effusions were seen in seven patients. CONCLUSION: The thin-section CT manifestations of Cytomegalovirus pulmonary infection usually consist of a mixture of patterns, most commonly ground-glass attenuation, areas of consolidation, and small nodules.  相似文献   

20.
目的:观察甲型H1N1流感肺炎治疗前后影像变化,探讨其转归影像表现。方法:回顾性分析25例甲型H1N1流感并发肺炎患者临床及治疗前后影像资料,其中男18例,女7例。结果:轻症12例,病变仅限于1个肺叶内,表现为片状磨玻璃密度影,临床以流感样症状为主,治疗后9例完全吸收,3例基本吸收。重症6例,病变累及单侧2个或双侧2个肺叶的片状阴影,以肺实变为主,临床表现为重症肺炎,治疗后1例炎症基本吸收,2例部分肺叶病变基本吸收,部分肺叶病变吸收后残留间质增生及纤维化,另3例炎症吸收后残留间质增生及纤维化。危重症7例,表现为双肺广泛分布的大片状实变影和/(或)磨玻璃密度影,临床表现为病情危重,治疗过程中3例病情存在反复,无明显吸收;4例治疗后炎症部分吸收并残留间质增生及纤维化。结论:甲型H1N1流感肺炎以磨玻璃密度影及斑片状阴影为主,影像表现多样,治疗后轻症者多完全吸收,重症及危重症者多残留间质增生及纤维化。  相似文献   

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