细菌性、病毒性及支原体肺炎的高分辨率CT征象分析与鉴别

 目的 分析细菌性肺炎、病毒性肺炎及支原体肺炎的高分辨率CT征象特征及鉴别要点。方法 对192例经病原学证实的单一病原体肺炎患者的高分辨率CT影像学资料进行回顾性分析。根据病原学将其分为细菌性肺炎组(n=84,43.8%)、病毒性肺炎组(n=58,30.2%)和支原体肺炎组(n=50,26.4%),对三组肺炎的临床资料、病变部位和CT征象进行比较。结果 细菌性肺炎的白细胞计数、C反应蛋白和降钙素原均显著高于病毒性和支原体肺炎(P＜0.05);支原体肺炎白细胞计数高于病毒性肺炎(P＜0.05);在病变分布上,病毒性肺炎多呈多肺叶(40/58,69%,P＜0.05)和肺外周分布(39/58,67.2%,P＜0.05);支原体肺炎多呈多肺叶(28/50,56%,P＜0.05)和肺下叶分布(31/50,62%,P＜0.05)。在CT征象上,细菌性肺炎肺实变(48/84,57.1%,P＜0.05)和含气支气管征(41/84,48.8%,P＜0.05)多见;在磨玻璃影和碎石征方面,病毒性肺炎(分别为30/58,51.7%和26/58,44.8%)和支原体肺炎(分别为31/50,62%和19/50,38%)无统计学差异(P＞0.05),但两者上述征象均较细菌性肺炎多见(P＜0.05);另外,病毒性肺炎间质增厚多见(32/58,55.2%,P＜0.05);支原体肺炎支气管壁增厚多见(29/50,58%,P＜0.05)。结论 细菌性肺炎主要表现为片状实变影常伴含气支气管征,病毒性肺炎主要表现为多叶外周性分布的磨玻璃影伴碎石征及间质增厚,支原体肺炎主要表现为双下肺分布为主的间质性炎性反应伴细支气管壁增厚。     

Exogenous lipoid pneumonia: HRCT, MR, and pathologic findings

The objective of this study was to describe high-resolution CT (HRCT) and MR findings of exogenous lipoid pneumonia and to correlate them with pathologic findings. A retrospective review of the medical records of our institution revealed seven patients with a diagnosis of lipoid pneumonia based on clinical data, chest films, bronchoalveolar lavage, and follow-up. Both HRCT and MR imaging were reviewed by two readers. Pathologic examination of the resected specimen or surgical biopsies were also reviewed in the four available cases. The HRCT findings were pulmonary consolidations (n = 6) with fatty (n = 3) or unspecific but low attenuation values (n = 3), areas of ground-glass opacities (n = 5), septal lines, and centrilobular interstitial thickening (n = 5). In five of the seven cases, a crazy-paving pattern of various spread was also present, either isolated (n = 1) or surrounding a pulmonary consolidation. In two cases traction bronchiectasis and cystic changes consistent with fibrosis were seen. At MR imaging (n = 2) a pulmonary consolidation of high signal intensity on T1-weighted image consistent with lipid content was present in one case. Pathologic examination (n = 4) showed the coexistence of lobules with lesions of various ages, sometimes in contiguous lobules, within the same patient. Recent lesions were those with alveolar fill-in by spumous macrophages and almost normal alveolar walls and septae. In more advanced lesions, lobules were filled in with larger vacuoles often surrounded by inflammatory infiltrates of alveolar walls, bronchiolar walls, and septa. The oldest lesions were characterized by fibrosis and parenchymal distortion around large lipid-containing vacuoles. The HRCT findings reflect pathologic findings in exogenous lipoid pneumonia. Although non-specific, consolidation areas of low attenuation values and crazy-paving pattern are frequently associated in exogenous lipoid pneumonia and are indicative of the diagnosis. Received: 24 July 1998; Revision received: 30 December 1998; Accepted: 1 February 1999     

Staphylococcal pneumonia associated with pneumatoceles, bilateral pyopneumothorax and sepsis

A case of soldier with community acquired staphylococcal pneumonia and multiple pneumatoceles as the rare complication in adults is presented. Their recognition provides appropriate treatment. In the patient were developed bilateral pneumothorax, pleural empyema and sepsis. Surgical treatment was performed by thoracic drainage. Recovery of pulmonary function was poor, as distinguished from children.     

Tetanus, pneumonia, and malaria in a tsunami victim in Banda Aceh, Indonesia

On December 26, 2004, a tsunami from the Indian Ocean struck the coastal city of Banda Aceh, Sumatra, Indonesia. This case report describes a 24-year-old woman who presented to the Dr. Zainoel Abidin Hospital in Banda Aceh on January 8, 2005, with a tsunami-related illness. The patient was initially treated for tetanus and aspiration pneumonia with a guarded prognosis. Her recovery was complicated by malaria and recurrent pneumonia. Treatment was hampered by a shortage of medication and equipment, damage to the hospital, and a filthy environment. Morphine, diazepam, and ketamine infusions were used to good effect. This case highlights some of the logistical problems of treating multiple tetanus patients in an austere environment.     

Community-acquired and nosocomial pneumonia

Pneumonia is one of the leading causes of morbidity, hospitalization, and mortality in both industrialized and developing countries. In particular, pulmonary infections acquired in the community, and pneumonias arising in the hospital setting, represent a major medical and economic problem and thus a continuous challenge to health care. For the radiologist, it is important to understand that community-acquired pneumonia (CAP) and nosocomial pneumonia (NP) share a number of characteristics, but should, in many respects be regarded as separate entities. CAP and NP arise in different populations, host different spectra of causative pathogens, and pose different challenges to both the clinician and the radiologist. CAP is generally seen in outpatients, is most frequently caused by Streptococcus pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae, and Chlamydia, and its radiologic diagnosis is relatively straightforward. NP, in contrast, develops in the hospital setting, is commonly caused by gram-negative bacteria, and may generate substantial problems for the radiologist. Overall, both for CAP and NP, imaging is an integral component of the diagnosis, important for classification and differential diagnosis, and helpful for follow-up.     

Community-acquired and nosocomial pneumonia

Pneumonia is one of the leading causes of morbidity, hospitalization, and mortality in both industrialized and developing countries. In particular, pulmonary infections acquired in the community, and pneumonias arising in the hospital setting, represent a major medical and economic problem and thus a continuous challenge to health care. For the radiologist, it is important to understand that community-acquired pneumonia (CAP) and nosocomial pneumonia (NP) share a number of characteristics, but should, in many respects be regarded as separate entities. CAP and NP arise in different populations, host different spectra of causative pathogens, and pose different challenges to both the clinician and the radiologist. CAP is generally seen in outpatients, is most frequently caused by Streptococcus pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae, and Chlamydia, and its radiologic diagnosis is relatively straightforward. NP, in contrast, develops in the hospital setting, is commonly caused by gram-negative bacteria, and may generate substantial problems for the radiologist. Overall, both for CAP and NP, imaging is an integral component of the diagnosis, important for classification and differential diagnosis, and helpful for follow-up.     

COVID-19 pneumonia: lessons learned,challenges, and preparing for the future

Coronavirus disease 2019 (COVID-19) is a viral disease that causes life-threatening health problems during acute illness, causing a pandemic and millions of deaths. Although computed tomography (CT) was used as a diagnostic tool for COVID-19 in the early period of the pandemic due to the inaccessibility or long duration of the polymerase chain reaction tests, current studies have revealed that CT scan should not be used to diagnose COVID-19. However, radiologic findings are vital in assessing pneumonia severity and investigating complications in patients with COVID-19. Long-term symptoms, also known as long COVID, in people recovering from COVID-19 affect patients’ quality of life and cause global health problems. Herein, we aimed to summarize the lessons learned in COVID-19 pneumonia, the challenges in diagnosing the disease and complications, and the prospects for future studies.

Main points

• Radiologic findings are vital in assessing pneumonia severity, prognosis, the presence of coinfections, and investigating complications in COVID-19.
• Pulmonary thromboembolism is a poor prognostic factor for COVID-19 patients.
• Long-term symptoms experienced by people recovering from COVID-19 (Long COVID) are also significant health problems.
• There is an increased risk of secondary infections, some of which can be fatal, in COVID-19 patients.

At the end of 2019, pneumonia cases of unknown cause emerged in Wuhan, China. Later, scientists determined that this pneumonia agent was a previously unknown betacoronavirus [severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)].¹ Then, the World Health Organization declared the disease [coronavirus disease 2019 (COVID-19)] caused by SARS-CoV-2 a pandemic.² The most prevalent problems in COVID-19 patients during acute illness are pneumonia, respiratory failure, sepsis, and death. In addition to patient-related factors, coinfections and superinfections are essential causes of poor prognosis in COVID-19 patients during acute illness.³ Radiologic findings are vital in assessing pneumonia severity, prognosis, the presence of coinfections, and investigating complications in COVID-19.^4-6 In addition to acute illness, long-term symptoms experienced by people recovering from COVID-19 are also significant health problems reported more frequently.⁷ Herein, we provide an overview of the lessons learned in patients with COVID-19 pneumonia, the early and long-term complications of COVID-19 pneumonia, and the prospects for future studies.     

High-resolution computed tomography features of nonspecific interstitial pneumonia and usual interstitial pneumonia

OBJECTIVE: To assess the accuracy of high-resolution computed tomography (HRCT) in the diagnosis of nonspecific interstitial pneumonia (NSIP). We hypothesized that the computed tomography (CT) features of NSIP could be distinguished from those of usual interstitial pneumonia (UIP). METHODS: The HRCT images of 47 patients with surgical lung biopsy-proven NSIP (n = 25) and UIP (n = 22) were independently reviewed by 2 thoracic radiologists. Predominant imaging patterns, most likely diagnosis, and diagnostic level of confidence were recorded. A confident HRCT diagnosis of NSIP was based on the presence of spatially uniform, bilateral, basal-predominant ground-glass and/or reticular opacities with little if any honeycombing, whereas UIP was confidently diagnosed if a spatially inhomogeneous, bilateral, peripheral, basal-predominant pattern of reticular opacities and honeycombing with little if any ground-glass attenuation was identified. RESULTS: A predominant pattern of ground-glass and/or reticular opacity with minimal to no honeycombing was demonstrated in 48 (96%) of 50 readings in patients with NSIP. Conversely, the presence of honeycombing as a predominant feature had a predictive value of 90% for UIP (P < 0.001). Usual interstitial pneumonia was more likely than NSIP to be subpleural and patchy (P < 0.001). A confident CT diagnosis of NSIP and UIP was correct in 73% and 88% of cases, respectively. The correctness of a CT diagnosis made at intermediate or high confidence was 68% and 88%, respectively. The kappa value for distinction of NSIP from UIP was 0.72. CONCLUSION: In contrast to previous reports, NSIP can be separated from UIP in most cases. The presence of honeycombing as a predominant imaging finding is highly specific for UIP and can be used to differentiate it from NSIP, particularly when the distribution is patchy and subpleural predominant. The presence of predominant ground-glass and reticular opacity is highly characteristic of NSIP, but there is a subset of patients with UIP who have this pattern and may require biopsy for differentiation from NSIP.     

炎症型细支气管肺泡细胞癌与肺炎的CT征象对比分析

目的探讨炎症型细支气管肺泡细胞癌（BAC）与肺炎的CT征象特点,提高对两种疾病的鉴别诊断水平。方法回顾性对比分析12例炎症型BAC及20例肺炎的CT征象。结果炎症型BAC主要分布于肺外带胸膜下,CT表现为磨玻璃样密度背景下的斑片状实变影,常伴空泡征、病理性含气支气管征及血管征、＂卫星＂腺泡结节、胸膜凹陷征及分叶征,一般无胸膜增厚;而肺炎常分布于中下肺叶,少见磨玻璃样密度、空泡征、病理性含气支气管征、分叶征及胸膜凹陷征,无＂卫星＂腺泡结节,慢性肺炎常可见邻近胸膜增厚。炎症型BAC与肺炎均不易引起肺门及纵隔淋巴结肿大。结论 CT检查对炎症型BAC与肺炎的鉴别诊断可提供重要依据。     

Usual interstitial pneumonia: correlation of CT with clinical, functional, and radiologic findings

Correlation between disease extent on computed tomographic (CT) scans and severity of clinical and functional impairment was obtained in 23 patients with usual interstitial pneumonia (UIP) by review of the clinical data, pulmonary function tests, chest radiographs, and CT scans. The CT scans and chest radiographs were each read twice by two independent observers. Disease extent was assessed on CT scans by a visual score (0%-100% involvement of the lung parenchyma) and on the radiograph by the International Labour Office classification. There was good intraobserver and interobserver agreement for both CT and radiograph scores (all r greater than or equal to .71). CT scans gave a better estimate of disease extent and showed more extensive honeycombing than did the radiograph. A significant correlation was found between the extent of disease as assessed with CT and the severity of dyspnea (r = .62, P less than .001), as well as between CT and impairment in gas exchange as assessed by the diffusing capacity (r = .64, P less than .001). There was poor correlation between disease severity as assessed with chest radiography and the clinical and functional variables (all r less than or equal to .39).     

Comparison of high-resolution computed tomography findings between Pseudomonas aeruginosa pneumonia and Cytomegalovirus pneumonia

Objective

To compare pulmonary high-resolution CT (HRCT) findings in patients with Pseudomonas aeruginosa pneumonia to HRCT findings in patients with Cytomegalovirus (CMV) pneumonia.

Methods

We studied 124 patients (77 men, 47 women; age range, 20–89 years; mean age, 65.4 years) with P. aeruginosa pneumonia and 44 patients (22 men, 22 women; age range, 36–86 years; mean age, 63.2 years) with CMV pneumonia.

Results

CT findings of consolidation (p?p?p?p?P. aeruginosa pneumonia than in those with CMV pneumonia. Centrilobular nodules, a crazy-paving appearance, and nodules were significantly more frequent in patients with CMV pneumonia than in those with P. aeruginosa pneumonia (all p?Conclusion Pulmonary HRCT findings, such as bronchial wall thickening, crazy-paving appearance, and nodules may be useful in distinguishing between P. aeruginosa pneumonia and CMV pneumonia.

Key Points

? Distinguishing Pseudomonas aeruginosa pneumonia from Cytomegalovirus pneumonia is important. ? Characteristic features of underlying conditions are present in each pneumonia species. ? Bronchial wall thickening and cavities are more frequent in Pseudomonas aeruginosa pneumonia. ? Nodules and a crazy-paving appearance are more frequent in Cytomegalovirus pneumonia.     

Chlamydia pneumoniae pneumonia and Mycoplasma pneumoniae pneumonia: comparison of clinical findings and CT findings

The objective of this study was to identify the clinical and pulmonary CT findings associated with Chlamydia pneumoniae pneumonia and to compare them with those of Mycoplasma pneumoniae pneumonia. The clinical features and CT scans of 40 patients with C. pneumoniae pneumonia and 42 patients with M. pneumoniae pneumonia were retrospectively reviewed. There were no significant differences between the two etiologic agents with regard to clinical signs. Chest CT findings in patients with C. pneumoniae pneumonia consisted mainly of ground-glass attenuation (n = 38) and acinar patterns (n = 28). Acinar patterns and pleural effusions (n = 12) were observed significantly more frequently than in patients with M. pneumoniae pneumonia (P < 0.0001, P < 0.039, respectively). CT findings of centrilobular nodules and bronchial wall thickening were significantly less common than in the M. pneumoniae pneumonia patients (P < 0.0001, P < 0.0001, respectively). The CT finding of acinar patterns, although nonspecific, can be considered suggestive of C. pneumoniae pneumonia.