艾滋病合并播散性隐球菌病的胸腹部CT表现分析

目的分析艾滋病合并播散性隐球菌病的胸腹部CT表现。方法选择我院2013年1月~2017年10月收治的20例艾滋病合并播散性隐球菌病患者作为研究对象,对所有患者均行胸部CT平扫,12例患者行胸部增强扫描,9例行腹部平扫,6例行两到三期腹部增强扫描,观察患者的肺内病灶、纵隔肺门病灶情况、腹部各器官病变情况。结果胸部CT扫描显示20例患者均有肺内结节,其中12例可见气囊状空洞性结节,4例为空泡状结节,6例呈毛玻璃样模糊影,3例为微小结节,6例为纵隔肺门淋巴结肿大,且增强扫描显示均有不同程度强化,3例伴有少量胸腔积液,2例伴有心包积液,1例有条带影。腹部CT提示7例肝脾脏肿大,2例肠系膜淋巴结肿大,1例腹膜后淋巴结肿大,1例为肾内淋巴结肿大,1例伴有腹水,腹部增强扫描提示5例呈环状强化。结论肺内结节、肺内实变、空洞性病灶并腹部CT扫描多处器官淋巴结肿大提示艾滋病患者有很大可能患有播散性隐球菌病,可以提早诊断并治疗。     

226例艾滋病合并马尔尼菲青霉菌病患者的影像学特征

目的探讨艾滋病合并马尔尼菲青霉菌病患者的影像学特征。方法回顾性分析云南省传染病专科医院收治的226例艾滋病合并马尔尼菲青霉菌病患者CT扫描和腹部超声影像学表现。结果 81.9%患者CD4+T淋巴细胞50cells/μl。82.7%患者胸部CT异常,胸部CT表现为肺野斑片状浸润阴影或局限性肺实变(45.6%)、结节影(11.9%)、毛玻璃改变(11.5%),弥漫性粟粒样病变(8.4%)、结节状肿块影(5.3%)。伴肺门或纵隔淋巴结肿大(45.1%),胸腔积液(23.5%),空洞病灶(8.0%)。90.3%患者腹部B超异常,腹部超声显示脾脏肿大(63.7%),腹腔淋巴结肿大(58.0%),肝脏肿大(20.8%),腹腔积液(13.3%)。3.5%患者头颅CT异常,表现为脑室扩张或颅内低密度影。结论艾滋病合并马尔尼菲青霉菌病多发生在CD4+T淋巴细胞50cells/μl的患者,常同时出现胸部和腹部影像学异常,少数出现头颅影像学异常。胸部影像学主要表现为斑片状浸润阴影或局限性肺实变,部分表现为结节影、毛玻璃改变、粟粒样病变、结节状肿块影。常伴肺门或纵隔淋巴结肿大,较少形成空洞病灶。腹部超声常表现为肝脾肿大和腹腔淋巴结肿大。     

艾滋病合并肺结核36例CT征象分析

目的分析艾滋病合并肺结核患者的临床资料及CT征象,总结其CT影像特征,提高对艾滋病合并肺结核的影像诊断水平。方法收集36例艾滋病合并肺结核患者的临床资料及CT征象,并分析总结其胸部CT影像特点。结果艾滋病合并肺结核胸部影像表现有其特征性:多为多种形态病灶并存,多叶多肺段同时累及,肺部病灶形态以斑片结节影、胸膜粘连、条索影、纵膈淋巴结肿大为主,空洞少见。结论艾滋病合并肺结核的临床表现有其特征性,临床医生应该结合其特点,提高诊断率。     

80例艾滋病合并肺结核患者胸部CT影像学特征研究

目的观察分析艾滋病合并肺结核中胸部CT影像学特征的临床诊断价值。方法选取本院2016年1月至2018年7月间80例诊断为艾滋病合并肺结核患者为研究对象,均对患者行胸部CT检查,分析胸部CT的影像学特征,明确该方法的诊断价值。结果 80例患者的临床分型中,Ⅰ型肺结核8例,Ⅱ型肺结核16例,Ⅲ型肺结核54例,Ⅳ型肺结核2例。有10例患者的病灶累及一叶,5例累及两叶,65例患者病灶累及在三叶及以上;其中,病灶累及位置在右肺上叶者69例、中叶80例以及下叶72例。艾滋病合并肺结核的CT检查形态多种多样,其中病变形态以斑片状影(85.00%)、纵隔淋巴结增大(75.00%)、结节状影(35.00%)、胸腔积液(27.50%)、片状影(21.25%)以及斑点状影(18.75%)多见。结论 CT影像学表现呈现出多种多样的形态,并有多性质病灶共存的现象,在CT中常表现出斑片状影、纵隔淋巴结增大、结节状影以及胸腔积液等,但均不是该病的特异性征象。因此,当艾滋病的患者其胸部CT检查结果同时呈现出上述的多种征象,则在临床上应当高度怀疑合并存在有肺结核疾病。在临床上对于表现相对不典型的症状需要结合临床实际以及实验室检查、病理分析等手段,对该病进行有效的早期诊治。     

艾滋病合并肺弥漫粟粒结节的高分辨率CT特征

目的探讨艾滋病(AIDS)伴肺弥漫粟粒结节患者诊断过程中高分辨率CT(HRCT)主要特征。方法选取2015年2月~2017年8月在本院接受CT检查的33例AIDS伴肺弥漫粟粒结节患者作为对象,回顾分析患者诊断结果。结果 33例患者中,15例为结核分枝杆菌感染,11例为马尔尼菲青霉菌感染,5例为曲霉菌感染,2例为葡萄球菌;结节分布情况:结核分枝杆菌感染者中,小叶中心分布、随机分布分别为3例、11例,1例为小叶中心分布、随机分布并存;马尔尼菲青霉菌感染者中,小叶中心分布、随机分布分别为3例、6例,2例两类型分布并存;曲霉菌感染者中,随机分布、小叶中心分布分别为1例、3例,1例为两类型分布并存;毛霉菌感染者均为随机分布;CT胸部伴随征象显示,肺弥漫粟粒结节伴随胸腔积液与AIDS合并结核病诊断存在显著性相关(P0.05)。结论 HR CT检查中结合伴随征象诊断、鉴别AIDS伴肺弥漫粟粒结节,能够取得更理想诊断效果。     

转移性皮肤腺癌一例

<正>临床资料患者,男,70岁。2018年6月因咳嗽、咳痰、气短就诊于我院呼吸科,胸部CT提示:右肺下叶不规则团块影,约4.8 cm×4.4 cm,边缘多发毛刺,右肺多发软组织结节,左肺多发微小结节灶,右肺门及纵隔多发淋巴结影,右侧胸腔内见积液影(图1a)。胸腔穿刺置管引流,CT引导下肺穿刺活检,病理:胸水离心石蜡包埋查见腺癌细胞,免疫组化:BerEP4(+),CK5/6(-),CK7(+),TTF-1(-),WT-1(-),Calreti     

伴肺动脉瘤破裂的白塞综合征

报告1例白塞综合征并发肺动脉瘤破裂。患者男,29岁。因咳嗽、咯血1年余,加重1个月入院。肺动脉CT血管造影(CTA)检查:双肺动脉及其分支多数被周围软组织影包绕,并左上舌段、左下肺动脉分支截断,右肺中叶动脉中段扩张、远段截断及以远带状软组织密度影,左肺下叶前基底段肺动脉外形不规则。左肺下叶后基底段胸膜下楔形软组织密度影。考虑肺动脉血管炎,结合既往有口腔、外阴反复溃疡史2年,针刺反应(+),胸部、背部及下肢可见散在毛囊性脓疱样疹,诊断为白塞综合征(多系统损害);右肺肺动脉瘤并大咯血。     

非感染性肉芽肿

20072551结节病的CT表现/魏雪梅(新疆维吾尔自治区医院呼吸内科),李芬宇∥新疆医学.-2007,37(2).-48~4920例患者,男3例,女17例,年龄26~57岁。胸部CT表现:左右气管旁,主动脉弓旁,主动脉弓下,气管前间隙及肺门淋巴结肿大;②双肺散在分布的粟粒或结节影,直径2~10mm,双中下肺支气管     

并发肺转移的头面部血管肉瘤

报告1例并发肺转移的头面部血管肉瘤.患者男,81岁.头面部出现多发性紫红色丘疹、结节和斑块10个月.皮损组织病理学检查:真皮梭形细胞增生,形成不规则管腔.免疫组化染色示CD31、Ⅷ因子、CD34阳性.患者近3个月出现胸闷,胸部X线及CT检查见肺内有多发性结节影.提示右肺内和左胸膜下肿瘤转移可能,最后诊断为头面部血管肉瘤并发肺转移.     

皮肤淀粉样变病并结节型肺淀粉样变1例

目的探讨原发性皮肤和肺淀粉样变病的诊断、治疗及预后。方法对1例原发性皮肤并肺淀粉样变病人的临床表现、实验室检查及治疗进行总结。结果病人皮肤主要表现为网状褐色斑、苔藓样变和结节,皮损组织病理见均质嗜伊红物质沉积于真皮乳头和网状层,刚果红染色阳性;肺部CT显示结节、纤维状条索、斑片状高密度影、纵隔淋巴结肿大,结节切除后,病理结果显示淀粉样变。结论混合型皮肤淀粉样变临床少见,并发临床罕见的结节型肺淀粉样变,诊断依靠病理活检,目前尚无特异性治疗,但抗炎、抗菌治疗可改善临床症状。     

Pleural effusions in patients with AIDS

OBJECTIVE: To describe the range of pathology causing pleural effusions in HIV infected patients with acute respiratory episodes and to attempt to identify whether any associated radiological abnormalities enabled aetiological discrimination. METHODS: Prospective study of chest radiographs of 58 consecutive HIV infected patients with pleural effusion and their microbiological, cytological, and histopathological diagnoses. RESULTS: A specific diagnosis was made in all cases. Diagnoses were Kaposi's sarcoma, 19 patients; para-pneumonic effusion, 16 patients; tuberculosis, eight patients; Pneumocystis carinii pneumonia, six patients; lymphoma, four patients; pulmonary embolus, two patients; and heart failure, aspergillus/leishmaniasis, and Cryptococcus neoformans, one case each. Most effusions (50/58) were small. Bilateral effusions were commoner in Kaposi's sarcoma (12/19) and lymphoma (3/4) than in para-pneumonic effusion (3/16). Concomitant interstitial parenchymal shadowing did not aid discrimination. A combination of bilateral effusions, focal air space consolidation, intrapulmonary nodules, and/or hilar lymphadenopathy suggests Kaposi's sarcoma. Unilateral effusion with focal air space consolidation suggests para-pneumonic effusion if intrapulmonary nodules are absent: if miliary nodules and/or mediastinal lymphadenopathy are detected, this suggests tuberculosis. CONCLUSIONS: A wide variety of infectious and malignant conditions cause pleural effusions in HIV infected patients, the most common cause in this group was Kaposi's sarcoma. The presence of additional radiological abnormalities such as focal air space consolidation, intrapulmonary nodules, and mediastinal lymphadenopathy aids aetiological discrimination.     

恶性胸膜间皮瘤病例报告和分析

目的分析恶性胸膜间皮瘤的临床病例特点,以探讨早期诊断、治疗的方法。方法1998年～2008年收入院11例恶性胸膜间皮瘤患者,男7例,女4例,年龄（63．7±12．6）（41～79）岁,均经病理资料确诊;对其临床资料进行回顾性分析。结果11例患者中10例（90．91％）有呼吸困难和胸痛的症状。11例（100％）患者均有胸腔积液。5例（45．45％）CT表现为胸膜肥厚,3例（27．27％）表现为胸膜结节影。对其中7例患者的胸腔积液的分析表明,7例胸水CEA水平均在正常范围,其中2例行CYFRA21—1检查,CYFRA21—1均升高;7例患者血清学肿瘤标记物CEA检查均在正常范围,其中6例（85．71％）行血清学CYFRA21—1检查提示均升高。结论恶性胸膜间皮瘤最常见的症状是呼吸困难和胸痛。CT对于恶性胸膜间皮瘤的诊断价值高于胸部X线：胸腔积液肿瘤标记物CYFRA21—1水平高而CEA水平正常对于恶性胸膜间皮瘤的诊断具有提示意义．     

艾滋病合并肺结核的影像学特征

目的　探讨艾滋病合并肺结核的影像学特征。方法　总结 1995年 1月～ 2 0 0 2年 5月本院收住的 11例艾滋病合并肺结核患者 ,对其胸部X线片及CT、HRCT等影象学表现进行分析。结果　①临床分型 :浸润型肺结核 6例 ,血行播散型 4例 ,原发性肺结核 1例。②影象学改变 :胸部X线片以多发片状、小片状渗出阴影混有小结节状病灶为主要表现 ,多有融合趋势 ;CT为多叶段侵犯、片状阴影及腺泡样结节等多种病灶阴影共存 ,呈双肺随机分布 ,病灶中心浓密 ,周围浅淡而模糊。结论　AIDS合并肺结核后 ,具有一定影像学特征 ,主要表现为“三多三少” ,即多种性质的病灶共存、多形态、多叶段分布 ;纤维化、钙化、肿块样阴影少见。     

Ethosuximide‐induced drug reaction with eosinophilia and systemic symptoms with mediastinal lymphadenopathy

Lymphadenopathy is a common sign for drug reaction and eosinophilia with systemic symptoms (DRESS) syndrome, but hilar and mediastinal lymphadenopathy may be underreported. We describe a 7‐year‐old boy who started taking ethosuximide for absence seizures and presented with diffuse rash, fever, elevated transaminases, facial swelling, and hilar and mediastinal lymphadenopathy. His mediastinal lymphadenopathy was concerning for lymphoma, which led to more invasive testing to rule out malignancy. This report highlights an unusual and likely underreported presenting sign of DRESS syndrome in children.     

Hilar-lymphadenopathy predictive of cutaneous sarcoid

A case of hilar lymphadenopathy, a cardinal sign of extra-cutaneous sarcoidosis, is being described in detail. It continued to be a diagnostic dilemma until the appearance of several papules and/or nodules over the face, front and back of the upper chest. The diagnosis was clinched by demonstration of non-caseating, epithelioid naked granuloma and affirmative response to oral administration of prednisolone in dosage of 40 mg a day.     

Cutaneous tumefaction in empyema necessitatis

BACKGROUND: Empyema necessitatis refers to a collection of exudative fluid that extends directly from the pleural cavity to the thoracic wall to form a mass in the extrapleural soft tissue of the chest. It was an uncommon complication of tuberculous pleural effusion even in the pre-antibiotic era, and has also been associated with bacterial lung abscess, actinomycosis, blastomycosis, and malignancies. METHODS: Seven instances of chest wall mass lesion secondary to empyema necessitatis, diagnosed by fine-needle aspiration biopsy (FNAB), are reported. RESULTS: Three cases were tuberculous, two were mesotheliomatous, one was caused by pulmonary small cell carcinoma, and another was due to coexisting Actinomyces and Actinobacillus. In all patients, subsequent pleural fluid cytologies demonstrated empyema with the respective etiologies identified. CONCLUSIONS: The usefulness of FNAB in the diagnosis of empyema necessitatis, supported by radiographic imaging and ancillary procedures, is well illustrated by these seven cases.     

Development of thoracic sarcoid reactions associated with complete response to anti-PD-1 therapy in a patient with advanced cutaneous squamous cell carcinoma

In patients with advanced cutaneous squamous cell carcinoma (cSCC), positive efficacy data were reported for anti-PD-1 antibodies. However, anti-PD-1 treatment is associated with a wide range of immune-related adverse events (irAEs). Here, we report on a 78-year-old woman with a huge cSCC on the right cheek spanning from the temporal to the cervical region with evidence for infiltration of the parotid gland, right masseter muscle and right auditory canal. Ultrasound revealed cervical, submandibular and supraclavicular lymph node metastases on patient’s right side. On the basis of a medical hardship application, treatment with pembrolizumab was initiated. After two applications, a dramatic regression of the tumour was observed. At this point, the patient was switched to cemiplimab, which, in the meantime, had become available in Germany. After 3 months on cemiplimab, the tumour-related ulcer on the right cheek showed almost complete regression and all previously affected lymph nodes displayed no evidence for malignancy. Thoracic computed tomography (CT) scans revealed enlarged mediastinal and bilateral hilar lymph nodes assessed as primarily reactive. Three months later, however, mediastinal and bilateral hilar lymph nodes further increased in size, accompanied by radiological alterations of the lung parenchyma. Lymph node biopsies revealed sarcoid reactions (SRs) including fibrotic non-caseating epitheloid cell granulomas surrounded by lymphocytes. Since the patient did not display any clinical symptoms, cemiplimab treatment was continued following a 4-week break. Three months later, CT showed significant regression of the described enlarged lymph nodes and parenchymal lung changes. Twenty months after anti-PD-1 treatment, the patient was still in complete remission. In conclusion, we describe, for the first time, the case of a patient with advanced cSCC who developed disseminated thoracic SRs which were associated with dramatic regression of tumour masses. Thus, as with other irAEs, development of SRs might be indicative of an anti-tumour response to anti-PD-1 therapy.     

Subcutaneous nodules as the first clinical manifestation of sarcoidosis

We report the case of a 61-year-old male who presented with a febrile illness accompanied by arthralgia and myalgia. Two months later he developed multiple subcutaneous nodules and enlarged parotid glands. Later two erythematous plaques, clinically compatible with erythema nodosum (EN), were observed. Laboratory investigations revealed abnormal levels of angiotensin converting enzyme and chest radiography showed bilateral hilar enlargement. The biopsy of the cutaneous lesions demonstrated multiple non-caseating granulomas in the subcutaneous tissue without any alterations in the epidermis and the dermis. The cultures for Mycobacteria and fungi were both negative. The clinical picture and histopathological findings were compatible with subcutaneous nodular sarcoidosis. The response to steroid treatment was satisfactory.     

Cutaneous and pulmonary sarcoidosis in association with tattoos

Sarcoidosis encompasses a heterogeneous spectrum of clinical presentations, including sarcoidosis in association with tattoos. We report the development of cutaneous and pulmonary sarcoidosis in a patient with long-standing eyebrow tattoos whose cutaneous sarcoidosis almost completely resolved when treated with tacrolimus 0.1% ointment. A 70-year-old woman with a 3-year history of an erythematous eruption circumscribing her eyebrow tattoos presented with a chronic, nonproductive cough of 8 months' duration. Skin biopsy results demonstrated naked tubercles consistent with sarcoidosis. Results of radiographs and a computed tomography scan of the chest revealed multiple pulmonary nodules with mediastinal and hilar adenopathy. The results of transbronchial biopsy were consistent with the diagnosis of pulmonary sarcoidosis. Initial treatment with oral prednisone only improved the pulmonary sarcoidosis. The cutaneous sarcoidosis almost completely resolved after the addition of tacrolimus 0.1% ointment.     

Case of keratosis lichenoides chronica with atypical sarcoidal granulomatous inflammation

Keratosis lichenoides chronica (KLC) is a rare chronic disease characterized by violaceous, papular and nodular lesions typically arranged in a linear and reticulate pattern. The etiology of KLC is unknown, but it may be associated with internal diseases such as hypothyroidism, glomerulonephritis and lymphoproliferative disorders. Herein, we describe the case of 44-year-old male patient with characteristic lesions of KLC on the trunk and extremities, present for 12 years. The clinical diagnosis was proven by histopathological examination on several occasions. In the years following the diagnosis of KLC, he developed bilateral hilar and multiple mediastinal, cervical and inguinal lymphadenopathies and hepatosplenomegaly. In 2000, diffuse interstitial and then reticulonodular pulmonary infiltrates associated with fever, weight loss, malaise and subcutaneous nodules developed. Biopsies taken from peripheral and mediastinal lymph nodes, pulmonary parenchyma, pleural tissue, bone marrow and skin showed non-necrotizing granulomas, indicating a sarcoidal granulomatous reaction. Characteristic histopathological findings and the absence of atypical cells, clonality and a high proliferative index excluded lymphomas. Furthermore, detailed tests showed no evidence of an infectious granulomatous disease. As far as we know, this is the first reported case of KLC associated with a sarcoidal granulomatous reaction.