46例肺曲菌病的CT表现分析

目的 探讨利用螺旋CT诊断肺曲菌病的表现.方法 选取我院呼吸内科2006年5月～2009年2月收冶的46例肺曲菌病患者的临床资料,回顾性分析患者的CT表现.结果 在20例患者中,在CT图像中表现为炎性实变17例,单发或者多发性结节5例,肿块样浸润11例,曲菌球10例,支气管扩张2例,肺不张1例.结论 曲菌球是肺曲菌病的特征性改变,如果在CT影像学中发现肿块或者结节及其、胸膜下楔形肺实变、周围晕征等征象时.应该首先考虑到是肺曲菌病的可能,对于提高临床诊断正确率有重要意义.     

易误诊为周围型肺癌的肺真菌病影像和病理学分析

目的分析术前误诊为周围型肺癌的肺部真菌病患者临床表现、影像学检查和病理组织学检查特征,探讨误诊原因,提高深部真菌病的诊治水平。方法回顾性分析24例肺部真菌肿块误诊为周围型肺癌患者的临床、影像和病理资料。结果 24例肺部周围型真菌性肿块患者术前均未发现糖尿病、自身免疫性疾病、免疫缺陷性疾病和其它器官恶性肿瘤,临床及影像均诊断为周围型肺癌或高度疑似为周围型肺癌,行肺段切除或肺叶切除术,术后病理诊断为肺曲霉菌病8例、肺隐球菌病14例、组织胞浆菌病1例和孢子丝菌病1例。结论无其它基础性疾病且免疫功能正常者出现的周围型肺部肿块,不能过分依赖或单凭影像学表现诊断为肺癌,肺隐球菌病和曲霉菌病是周围型肺肿块常见的肺部真菌病,术前穿刺活检可避免误诊。     

孤立性部分实性肺结节28例影像学与临床病理分析

目的探讨孤立性部分实性肺结节不同病理学类型与临床及影像学特征的相关性。方法将28例孤立性部分实性肺结节分为良性组、浸润前病变组、微浸润腺癌组和浸润性腺癌组;分析上述不同病理类型部分实性肺结节在临床资料及CT影像学特征间的差异。结果 28例患者中良性病变3例、浸润前病变5例、微浸润腺癌12例、浸润性腺癌8例。不同病理类型的临床特征、组间差异,均无统计学意义(P均 0. 05)。不同病理类型中肺结节大小、外形、空泡征、支气管充气征、分叶或毛刺、实性成分大小及比例,在4组间差异有统计学意义(P均0. 05)。进一步两两比较:浸润性腺癌结节大小、外形、空泡征、支气管充气征、分叶或毛刺、实性成分大小及比例与其它组别相比,差异有统计学意义(P均0. 05);微浸润腺癌结节大小、空泡征、分叶或毛刺与良性、浸润前病变组相比,差异有统计学意义(P均0. 05)。以实性成分长径5 mm及占结节比例0. 25为界,其中长径5 mm且构成比 0. 25的浸润性腺癌明显高于其它组,差异有统计学意义(P均0. 05)。结论孤立性部分实性肺结节病理以微浸润及浸润性腺癌恶性病变为主。影像学特征与病理学存在一定相关性;结节越大、外形不规则,伴空泡征、支气管充气征、分叶或毛刺,多提示浸润性或微浸润腺癌;以实性成分长径5 mm及占结节比例0. 25为界,其中长径 5 mm且构成比 0. 25有助于浸润性腺癌诊断,为临床提供指导。     

54例肺结核球临床分析

目的 分析肺结核球的临床与影像学特点,探讨其疗效变化趋势.方法 收集临床病理证实且资料完整的肺结核球患者54例,综合分析其临床及影像学特征.结果 54例患者中,咳嗽、咳痰28例,胸痛、胸闷19例,咯血痰4例,低热盗汗16例,23例无症状; 影像学表现肺野内孤立存在的边缘较清楚的圆形病灶27例,长圆形23例;病灶外围轮廓整齐,边缘光滑的36例,呈分叶状4例,有毛刺5例,病灶周围有散在的结节状、片状或条状卫星病灶16例,周围胸膜有粘连增厚者4例.结论 结核病控制策略DOTS对结核球治疗可以取得满意疗效,在治疗过程中应注重其前后影像片的对照观察和临床表现变化,个别病例出现耐药性时,可考虑进行手术治疗.     

胸部炎性肌纤维母细胞瘤的CT及MRI评价

目的 探讨胸部炎性肌纤维母细胞瘤(IMT)的CT和MRI表现,提高其影像学诊断水平.方法 回顾性分析2005年2月至2009年11月广州医学院第一附属医院及中山大学附属肿瘤医院住院并经手术病理证实的13例胸部IMT的影像学表现.结果 13例病灶中,肺5例,纵膈2例,食道上段1例,右侧胸壁2例,左侧胸壁2例,气管1例.肺IMT 1例为中央型,4例为周围型,为边缘清楚或不清的单发肿块.肺外IMT均表现为大小不一的单个实性软组织肿块,密度均匀或不均匀.2例病灶内出现斑点状钙化,1例胸壁IMT伴肋骨破坏.MR表现为T1WI呈稍低信号,T2WI呈不均匀高信号.结论 CT、MRI检查可清晰显示IMT的大小、形态及与周围组织的关系,对选择手术方案及评价治疗效果有重要参考价值.     

肺隐球菌病37例临床病理分析

目的探讨肺隐球菌病的临床病理特征、诊断及鉴别诊断。方法收集安徽省胸科医院37例确诊为肺隐球菌病组织标本,对其临床病理特征、HE及特殊染色等进行回顾性分析,并复习相关文献。结果37例肺隐球菌病中男性20例,女性17例,年龄12~80岁,中位年龄45岁。常见临床症状有咳嗽、咳痰、胸痛,部分重症患者有慢性病或激素治疗史,另有15例患者无症状。常见胸部影像学表现有结节影18例,团块状、片状影19例,混合病变10例。4例行乳胶凝集试验检测均阳性,37例行六胺银染色均阳性。结论肺隐球菌病好发于青壮年,多数患者无免疫功能受损;临床及影像学表现无特异性;多数病例通过组织病理学确诊,六胺银等特殊染色有助于病理诊断;乳胶凝集试验可作为肺隐球菌病的首选辅助诊断手段。     

乳腺淋巴瘤的影像学特征及临床病理分析

目的:探讨乳腺淋巴瘤的影像学及临床、病理特征。方法:回顾分析2014年5月至2020年6月期间15例经病理证实并具有完整临床资料的乳腺淋巴瘤影像学特征。结果:15例乳腺淋巴瘤中12例为原发乳腺淋巴瘤（Primary breast lymphoma,PBL）,3例为继发乳腺淋巴瘤（Secondary breast lymphoma,SBL）。15例患者共21个病灶,病灶大小0.8～10.5cm。13例为B细胞来源淋巴瘤,2例为NK/T细胞淋巴瘤;13例接受X线检查,3例为多发结节肿块,8例为单发类圆形或不规则肿块,1例为左乳腺弥漫增大伴皮肤增厚,1例未见明显异常。15例均接受超声检查,共发现20个病灶,12个为低回声,6个为高低混杂回声,2个为无回声;9个可探及丰富血流信号,8个边缘可探及少量血流信号。7例患者接受CT检查,2例为多发结节肿块,5例单发类圆形或不规则肿块。结论:乳腺淋巴瘤的影像学表现具有一定特征性,对确诊有一定临床意义。     

实体器官移植后侵袭性肺曲菌病的CT表现

背景：实体器官移植后肺部感染的发病率和死亡率居高不下,尤其是作为机会感染的曲菌,早期诊断侵袭性肺曲霉菌病是困难的。 目的：总结实体器官移植后侵袭性曲菌性肺炎的CT表现。 方法：以“实体器官移植/肾移植/肝移植/肺移植/心脏移植,曲菌,真菌,霉菌,肺,侵袭性,体层摄影术,X线计算机”为中文捡索词,以“solid organ transplantation/renal transplantation/liver transplantation/lung transplantation/heart transplantation, aspergillosis,fungus,mold,pulmonary invasive, tomography computerized”为英文检索词,检索维普和中国知网(CNKI)期刊全文数据库、Medline,highwire和外文生物医学期刊全文数据库(Foreign Journals Integration System)2001年1月至2012年10月有关肺曲菌感染和真菌或霉菌肺感染报告中主要涉及曲菌的侵袭性曲菌肺炎CT表现的临床报道。然后二次人工检索实体器官移植后,纳入有关实体器官移植后侵袭性曲菌肺炎CT表现的文献,排除重复性研究和不典型报道。 结果与结论：实体器官移植后侵袭性肺曲霉菌病典型的胸部CT表现包括结节、肿块、实变以及磨玻璃影。随感染时间依次出现晕征、反晕征、空洞和空气半月征。这些征象的发生率的不同可能与CT检查时间和早期抗真菌治疗已经真菌预防性治疗有关。有意义的结果是侵袭性肺曲霉菌病征象与患者预后的关系。无实变或肿块和小腔空洞存在可能与更好预后相关。大结节、多发梗死性实变、肾脏替代治疗和持久性的血清半乳甘露聚糖阳性是90 d的死亡率独立的预测因子。而代表出血的晕征与90 d的死亡率无关。尽管报告较少,用CT肺血管造影诊断侵袭性真菌性肺炎是有前景的诊断手段,可以早期发现反映侵袭性血管受累的血管闭塞征,其敏感性和特异性优于晕征,与血清曲菌半乳甘露聚糖试验近似。     

肺硬化性血管瘤的CT影像学特点

目的分析肺硬化性血管瘤的CT表现,提高此疾病的影像学诊断能力。方法分析9例经病理证实的PSH的CT表现。结果CT平扫均表现为边界清楚的圆形或椭圆形肿块性病灶,9例病灶中均未见囊变、钙化。1例病灶周边可见"空气新月征"。增强后8例病灶均匀强化,1例不均匀强化;增强后CT值介于78～120Hu之间。结论中年女性CT征象表现为单发、圆形或椭圆形、边界清楚伴有重度均匀强化或空气新月征的肺内肿块时,应考虑到PSH的诊断。     

肝孤立性坏死结节1例报告并文献复习

目的：探讨肝孤立性坏死结节的临床、病理形态学特点、影像学及其鉴别诊断，以期对此疾病进行更加深入的理解。方法：收集临床资料并结合影像学及病理形态学检查结果，运用光镜及特染技术研究1例肝孤立性坏死结节并系统进行相关文献复习。结果：影像学、B超、CT、MRI检查均表现为边界尚清楚的低回声、低密度、低信号结节，且增强扫描后内部不强化。MRI增强后病灶环形强化。镜下结节为一粉染无结构的非干酪样坏死物构成，其内未见细菌、寄生虫等病原体入侵。结节周围可见透明变性纤维包膜包绕。病变周围为正常肝组织。病理诊断：肝孤立性坏死结节。结论：肝孤立性坏死结节有特异影像学和病理组织学表现，临床治疗方案为病灶切除，术后预后良好，不易复发。     

Malignant otitis externa--a high index of suspicion is still needed for diagnosis

Malignant otitis externa is a destructive inflammatory process of the petrous temporal bone which if untreated leads to osteomyelitis of the skull base and can be fatal. It is more common in immunocompromised and elderly insulin-dependant diabetic patients and is caused by infection with Pseudomonas species. Despite a range of laboratory and radiological tests it still remains difficult to diagnose, particularly in the early stages when it can be treated medically. We describe three cases which presented to this department in the past twelve months. In all cases the diagnosis was made clinically and confirmed per-operatively. Interestingly all three cases were relatively young patients who did not have an immunocompromised status and were not diabetic.     

Nocardiosis in transplant recipients

Nocardiosis is a rare opportunistic infection caused by Nocardia spp., an aerobic actinomycete, that mainly affects patients with cell-mediated immunity defects, such as transplant recipients. Despite recent progress regarding Nocardia identification and changes in taxonomic assignment, many challenges remain for the diagnosis or management of nocardiosis. This opportunistic infection affects 0.04 to 3.5 % of patients with solid organ or hematopoietic stem cell transplantation, depending on the organ transplanted, cytomegalovirus (CMV) infection, corticosteroids dose and calcineurin inhibitors level. Nocardiosis diagnosis relies on appropriate clinical, radiological and microbiological workup that includes the sampling of an accessible involved site and molecular microbiology tools. In parallel, extensive clinical and radiological evaluations are mandatory, including brain imaging, even in the absence of neurological signs. In transplanted patients, differential diagnosis is challenging, with co-infections reported in 20 to 64 % of cases. As the antibiotic susceptibility pattern varies among species, the antimicrobial regimen before species identification should rely on the association of antibiotics active on all species of Nocardia. Bactericidal antibiotics are required in cases of severe or disseminated disease. Furthermore, in transplant recipients, combination therapy is difficult to manage because of cumulative toxicity and interactions with immunosuppressive agents. Because of a high recurrence rate, antibiotic therapy should be prescribed for 6 to 12 months.     

Nucleic acid detection as a diagnostic tool in polyomavirus JC induced progressive multifocal leukoencephalopathy

Procedures involved in the diagnosis of JC virus central nervous system infection range from detection of virus specific products in biopsy material to demonstration of viral DNA in cerebrospinal fluid by PCR. Despite the fact that PCR is the most sensitive method for the detection of virus in clinical specimens, diagnostic evaluation is increasingly difficult in view of the possible subclinical activation of persistent JCV infection in the central nervous system of high risk patients. Therefore, PML diagnosis by molecular detection of JCV DNA in biopsy material was compared with diagnosis by PCR on CSF of patients with and without PML. Evaluation of the diagnostic techniques revealed that stereotactic biopsy based PCR diagnosis at present combines speed and sensitivity with the highest specificity available. Although the non invasive technique of JCV detection in CSF by PCR is even more sensitive leading to detection of about 20 genome equivalents per 1 |gml of CSF, the specificity of the method is limited by subclinical presence of JCV DNA in CSF of neurologically asymptomatic HIV infected patients. Additionally, autopsy proven PML cases remaining JCV negative in PCR on CSF become a common finding. Therefore, in cases where biopsy is not performed, diagnosis of PML can only be achieved in combination with neurological and radiological diagnosis. J. Med. Virol. 54:196–203, 1998. © 1998 Wiley-Liss, Inc.     

Clinical Strategy for the Management of Solid Pseudopapillary Tumor of the Pancreas: Aggressive or Less?

Objective: To further delineate the clinicopathological and radiological features of solid pseudopapillary tumor (SPT) of the pancreas and summarize the surgical therapy strategy for this tumor. Methods: A retrospective review of 18 pathologically confirmed cases of SPT was performed and the clinical and pathological features, radiological findings and surgical interventions were analyzed. Results: The patients included 17 females and 1 male with a median age of 23 years. The median diameter of the lesions was 8.0 cm. Abdominal pain was the predominant complaint (8/18). The rest of the patients were asymptomatic and presented with a pancreatic mass detected incidentally. Radiological study revealed a well-demarcated mass which was composed of a solid-cystic portion. On post-contrast CT, the solid portions could be enhanced whereas the cystic parts remained unenhanced. With the preoperative diagnosis of SPT in 11 patients and pancreatic cyst, benign or malignant pancreatic tumor in the rest, pancreatic tumor resection was successfully completed. Surgical exploration findings, pathological characteristics and good prognosis of the patients with SPT, indicated its low-grade malignant potential. Conclusion: In combination with clinical findings, radiological features of SPT may help to make the correct diagnosis and differentiation from other pancreatic neoplasms. Once diagnosed, given the excellent prognosis and low-grade malignancy, less aggressive surgical resection of the primary lesion is proposed.     

Pneumocystis carinii pneumonia after renal transplantation

Being immuno-suppressed, renal allograft recipients are at increased risk of contracting various infectious complications. Pneumocystis carinii pneumonia (PCP) is one of the important opportunistic infection causing high morbidity and mortality in these patients. Majority of studies has reported the occurrence of PCP during 6 months to one year after renal transplantation. This communication describes occurrence of PCP in five renal allograft recipients 10 weeks to 72 months after transplantation. In view of elusive presentation, strong clinical and radiological suspicion followed by direct demonstration of the organisms is essential for early diagnosis and prompt treatment. These observations also indicate that PCP is an emerging opportunistic infection in immuno-compromised patients in tropical countries.     

Necrosis in human spermatozoa. I. Ultrastructural features and FISH study in semen from patients with uro-genital infections

Ultrastructural characteristics and meiotic segregation in spermatozoa from twelve patients affected by uro-genital bacterial infections were investigated. The sperm quality was examined by light and transmission electron microscopy (TEM) and fluorescence in situ hybridization (FISH) analysis was performed in eight out of twelve individuals in order to investigate the meiotic behaviour of chromosomes namely gonosomes and chromosome 18. TEM analysis highlighted a severely altered sperm morphology, typical of apoptosis and in particular, necrosis. We define the ultrastructural characteristics of necrosis as involving the acrosome, chromatin, mitochondrial helix, axonemal structure and plasma membrane. Based on our observations, it is possible to hypothesize that infection acts at the testicular level causing sperm death, due to necrosis itself or by necrosis proposed as the final step of apoptosis. Moreover, FISH analysis revealed the presence of altered meiotic segregation in these patients. The high rate of diploidy and gonosomes disomy in our group of patients suggests the possibility of a negative effect of infection and/or inflammation on sperm morphogenesis.     

When a stroke is not a stroke; posterior leukoencephalopathy syndrome mimicking posterior circulation stroke

Posterior leukoencephalopathy syndrome (PLS) is a potentially reversible syndrome that may mimic the clinical and radiological features of posterior circulation cerebral infarction. Three cases of PLS are presented which were erroneously diagnosed as strokes and treated in accordance with recent evidence based guidelines; none of the cases fulfilled the current criteria requiring treatment for hypertension in the acute stroke setting. Once the diagnosis of PLS was made, and the patients blood pressure treated aggressively, all patients had rapid and full clinical resolution of their symptoms. Given the important differences in management and prognosis, rapid and accurate diagnosis is essential. Posterior leukoencephalopathy syndrome needs to be considered in patients presenting with clinical and/or radiological findings that predominantly affect the occipital lobes.     

肾移植后败血症7例

背景：由于免疫抑制剂及广谱抗生素的使用,使肾移植术后合并败血症的病原菌多样复杂,病情严重,致死率高。因此加强肾移植术后合并败血症临床病原学特点的认识,及早合适的治疗是提高感染治愈率的关键。 目的：分析肾移植后并发败血症的临床病原学特点与治疗情况。 方法：收集佛山市第一人民医院肾内科2007-06/2010-06的376例肾移植患者移植后并发败血症7例的临床资料,分别对其易感因素、病原学特点、临床表现及治疗方案进行回顾性分析。 结果与结论：7例患者均有寒颤、发热(体温38.5~42.0 ℃),烦燥、气促4例,尿路刺激症4例。血压低于90/60 mm Hg   (1 mm Hg=0.133 kPa)伴血肌酐增高4例。大肠埃希氏菌4例,表皮葡萄球菌1例,白色念珠菌1例,马尔尼菲青霉菌1例。5例细菌感染为院外感染,2例真菌感染者为院内感染。4例感染大肠埃希氏菌者合并尿路感染。4例低血压休克并急性肾功能衰竭。经抗感染治疗、减少免疫抑制药物用量及对症处理。6例痊愈,1例死亡。早期诊断,联合用药,减少免疫抑制剂的用量是提高感染治愈率的关键。     

Oro-facio-digital syndromes I and II: radiological methods for diagnosis and the clinical variations

In view of the different modes of inheritance and the different prognoses of the two oro-facio-digital syndromes, type 1 (OFD-I) and type 2 (OFD-II), it is important to establish a correct diagnosis in these patients. In this report two new patients with the OFD-I syndrome are presented. One of them (Case 1) had multiple congenital malformations and never made any mental contact. She died at the age of four months and autopsy of the brain revealed abnormalities typical of the syndrome, which are discussed. The other patient (Case 2) has so far had normal mental development. Although these two patients were affected to a very different degree, they both presented the clinical and radiological characteristics of the OFD-I syndrome. These two patients and previously reported cases of the OFD-I and OFD-II syndromes were compared with a patient with the OFD-II syndrome (Case 3), a patient reported earlier who is undergoing follow-up. The radiological features of the skeleton in the two syndromes are presented. The irregular mineralization of the hands and feet characteristic of OFD-I, but not of OFD-II, seems to offer a good opportunity to distinguish between these two syndromes. It is suggested that this finding is pathognomonic for the OFD-I syndrome.