Diagnostic imaging, preautopsy imaging and autopsy findings of

Background Aquired immune deficiency syndrome （AIDS） presents a challenge to medical researchers because of its unique pathological and clinical picture. The clinical data, particularly autopsy evidence, from China have failed to provide enough pathological and etiological evidence for AIDS diagnosis, which impairs the reliability of the diagnosis and our full understanding of the occurrence and development of AIDS complications. The purpose of this study was to investigate the imaging and pathologic characteristics of AIDS. Methods Autopsy, imaging and pathological data from 8 cases of AIDS were retrospectively analyzed. Routine CT scanning of different body parts was performed during their periods of hospitalization. Transverse CT scanning was conducted from the skull to the pelvis immediately after the occurrence of death. After routine formalin fixing, 7 cardevers were cross sectioned for autopsy in freezing state and 1 for gross autopsy. Tissues were obtained from each section and organs for pathological examinations. Results The autopsy data indicated the presence of parasitic infections, bacterial infections, fungal infections, and virus infections in AIDS patients. Pneumocystis pneumonia, pulmonary tuberculosis, coccobacteria pneumonia, Aspergillus pneumonia, cytomegaJovirus pneumonia, toxoplasma encephalitis, lymphoma and cerebrovascular diseases were found in these patients. Conclusions During the course of AIDS progression, the concurrent multiple infections as well as tumor development may resuJt in multiple organ pathological changes and clinically complex symptoms that further complicate the imaging and pathological manifestations, thus resulting in difficult differential diagnosis. A combination of imaging data and autopsy data can help to clarify the diagnosis.     

临床诊断与尸体检验诊断相关性研究

目的 比较临床诊断与尸体检验诊断结果,分析、评估临床误诊率.方法 回顾分析重庆医科大学法医教研室1988-2007年医疗纠纷尸体解剖356例,统计内容包括性别、年龄、在医院的时、科别,死亡疾病和医院的等级,比较尸体检验诊断与临床诊断的一致率.结果 临床诊断与尸检诊断完全一致的有162例(45.5%),临床诊断与尸检诊断不一致的有101例(28.4%),临床诊断与尸检诊断部分不一致的有63例(17.7%),无法比较的有30例(8.4%).误诊率最高的是循环系统和呼吸系统疾病,其中心肌病、主动脉粥样硬化与高血压致主动脉破裂、肺炎的误诊率最高.结论 科学的尸体检验不但为医疗事故的处理提供医学依据,而且为相关临床学科提高诊疗水平提供科学依据.     

肺炎46例尸检报告

本文报告了近１０年因肺炎致死或伴发肺炎而死尸检４６例。男３３例，女１３例，大叶性肺炎１０例，小叶性肺炎２５例，间质性肺炎８例，吸入性肺炎３例。总结了上前肺炎的临床病理特点，发病隐匿或突发或伴发其它疾病存在而被忽视，致病菌种类可能在变迁，病情严重并发症多见，预后不佳。大叶性肺炎多可突发直接致死，小叶性肺炎多伴其它疾病而加重病情，加速死亡。强调了临床上应提高对肺炎诊治的意义。     

Clinical manifestations of imaging demonstrations of AIDS-related nervous system infections

HIV is a neurotropic virus and can be engulfed macrophagocytes. It invades the brain tissue via the blood-brain barrier and multiplies in the cerebrospinal fluid （CSF）. HIV has been isolated from the brain, spinal marrow, peripheral nerve, and the CSF. Electronic microscopy, immunohistochemistry, and in situ hybridization have demonstrated monocytes and multinucleated cells containing HIV virus.     

47例肺血栓栓塞症患者尸检资料分析

目的 了解肺血栓栓塞症(PTE)患者尸检的临床及病理特点,提高对PTE的认识.方法 回顾性分析重庆医科大学2004-2015年经尸检证实为PTE的47例死亡患者的临床及病理资料.结果 12年间共完成尸检784例,其中PTE 47例(2例合并脂肪栓塞),发生率6.0％.47例PTE病例中有46例(97.9％)为致死性肺栓塞(FPE).分析47例PTE病例尸检资料发现,每例均至少存在一项危险因素,43例(91.5％)存在2项及以上危险因素,其中最常见危险因素为创伤骨折(55.3％)及手术(53.2％).临床症状以呼吸困难(40.4％)、心搏骤停(31.9％)及晕厥(27.7％)常见;24例(51.1％)合并下肢深静脉血栓形成(DVT),8例(17.0％)合并右心血栓,1例(2.1％)合并基底动脉血栓.栓塞部位以肺动脉主干(59.6％)多见,其中骑跨型栓塞20例(42.6％).22例(46.8％)死亡前疑诊为PTE,但均未行抗凝或溶栓治疗,仅1例予低分子肝素预防性抗凝治疗.结论 PTE容易继发于有高危因素的患者,尤其是创伤骨折及手术.其临床症状无特异性,缺乏典型三联征,误诊率、漏诊率及致死率均高,临床工作者对疑诊PTE患者治疗不充足.     

艾滋病相关卡波西肉瘤32例尸检材料病理学研究

目的：概况艾滋病相关卡产波西肉瘤（ＫＳ）病理特征，并探讨其两全是学分型、来源与性质。方法：所有病例均按常规尸检及制片，光镜观察，并复习资料。结果：ＫＳ累及皮肤２３例，呼吸系统２０例，消化道１７例，淋巴结１２例，２６例为播散性。肿瘤肉眼表现为斑型和结节型，镜下主要同增生的血管和梭形细胞构成。并常见胶原分、淋这扩张、嗜性小体、炎细胞浸浸、出血及含铁务黄素沉积等特征性病变。结论：ＫＳ是一种颇具特征的病变     

79例小儿尸检病例的临床与病理诊断对照分析

９例小儿尸检病例的临床与病理诊断作对照分析。结果显示：１４例误诊,误诊率为１７７２％;在～２８ｄ,～５岁,～１０岁和～１４岁４个小儿年龄组中,新生儿组误诊率为２９６３％,明显高于其他年龄组（Ｐ＜０．０５）,且日龄越小误诊率越高;呼吸系统疾病是误诊的主要病种,占４２８６％;而年长儿的２例误诊均为结核病。提示对新生儿疾病诊断时,要详细了解围生期情况,积极寻找原发病;结核病对儿童的致命威胁应引起儿科医生的高度重视。     

8例急性主动脉夹层猝死的尸解病理研究

目的分析急性主动脉夹层的临床和病理特点，提高临床确诊率。方法回顾分析8例急性主动脉夹层破裂出血死亡者的临床和病理资料。结果该病临床表现为持续性胸闷、胸痛或中上腹痛，EKG均无特殊改变。5例有高血压史的死者(平均年龄49．8岁)主动脉内膜有明显的粥样斑块伴溃疡形成；另3例死者(平均年龄22．3岁)无高血压史，其中1例具有Marfan综合征的表现。所有病例病理表现均为主动脉夹层破裂出血，中膜呈粘液囊性变，滋养血管破裂出血，弹力纤维断裂、缺失，同时有明显的肺气肿和肺大泡形成。结论对长期高血压的中老年患者以及无高血压而伴有一些遗传性结缔组织病或代谢性疾病的年轻人，若出现相应的临床症状，应充分考虑患AD的可能性，及时运用影像学诊断技术确诊，有助于早期治疗，降低死亡率。     

原发性脑淋巴瘤的CT、MRI表现与病理对照研究

目的探讨原发性脑淋巴瘤(PLB)的CT、MRI表现特征及病理基础。方法收集经手术、病理和免疫组化证实,资料齐全的PLB 17例,分析其CT、MRI及病理表现。结果17例患者中单发11例,多发6例,共25个病灶,分布于脑深部中线附近病灶19个(76.00%),分布于灰白质交界区及脑表面病灶6个(24.00%)。肿瘤形态多为类圆形肿块或结节,瘤周水肿多为轻至中度水肿。CT平扫多呈等密度或略高密度影。T1WI呈等、低信号,T2WI呈等、高信号,增强后呈明显均匀增强。B细胞来源的14例,多为LCA、CD20、CD79阳性;T细胞来源的3例,多为LCA、CD45RO、CD3阳性。结论PLB的病理学基础决定其CT及MRI表现特征,结合临床及影像学表现特征可以对该病作出正确诊断。     

乌鲁木齐地区5369例法医尸检资料的回顾性调查

目的：探讨法医尸检资料的统计分析及综合性研究对于法医的教学、科研、检案及了解不同地区各类案件及特点及差异性、加强社会治安综合治理等工作的重要意义。方法：对新疆维吾尔自治区乌鲁木齐地区1988－1996年间尸检资料,按照统一标准和要求进行了回顾性调查,并与国内外有关文献进行了比较。结果：乌鲁木齐地区作为我国最西部的一个城市在同一个时期发案率和案件性质上与其它省市有明显差异,暴力性死亡明显高于湖北及东北等地区,交通事故死亡人数象其它城市一样,逐年显著增加。结论：死亡性质上本地区以他杀最多见,本组资料可供今后开展法医尸检的全国性研究及本地区同仁实际检案时参考。     

乳腺肿块实时超声弹性成像与病理诊断的对照研究

目的探讨实时弹性成像对乳腺肿块良、恶性的诊断价值。方法对经手术病理证实的63个病灶进行实时超声弹性成像检查,采用筑波大学5分评分法进行评价,1～3分为良性,4～5分为恶性,以手术病理结果为诊断金标准,计算超声弹性成像的敏感性、特异性和准确性。结果超声弹性成像诊断的敏感性、特异性和准确性分别为78.2%、92.5%和85.7%。结论超声弹性成像有助于乳腺肿块良、恶性的鉴别诊断。     

Imaging and pathological findings of AIDS complicated by pulmonary Rhodococcus equi infection

Background  Rhodococcus equi (R. equi) infection commonly occurs in grazing areas, especially in patients with AIDS or with T-lymphocyte immuno-deficiencies. Literature reviews revealed that cases radiologically and pathologically diagnosed of AIDS complicated by R. equi infection are rare. This study aimed to investigate the imaging features and pathological basis of AIDS complicated by pulmonary R. equi infection.

Methods  A total of 13 cases of AIDS complicated by pulmonary R. equi infection were retrospectively analyzed based on their imaging, bacterial culture and pathological data, including 10 cases by chest CT scanning and X-ray radiology and 3 cases by only X-ray radiology. All 13 cases were definitely diagnosed by bacterial culture, including one by CT-guided pulmonary puncture with following H&E staining and periodic acid-Schiff (PAS) staining for diagnostic biopsy and another one by bronchial biopsy with following H&E staining and PAS staining for pathological diagnosis. The imaging findings and the pathological findings of AIDS complicated by pulmonary R. equi infection were compared and evaluated.

Results  Totally 9 subjects (70%) had radiological demonstrations of central ball liked high density shadows in unilateral pulmonary hilus areas; 10 (77%), cavities and liquefied levels; 3 (23%), pleural effussion. The foci were found in pulmonary inner zone in 10 subjects (77%) and in pulmonary outer zone in one subject (7%). The pathological findings included intra-alveolar hemorrhage, lymphocyte infiltration and granulation tissue proliferation, which were in line with the pathological process of necrotic pneumonia. After 8-month follow-up of anti-R. equi therapy of these 13 cases, 9 cases had obviously decreased or shrunk pulmonary cavities, one died, one missed follow-up, one completely absorbed foci and one did not receive reexaminations.

Conclusions  The radiological demonstrations of AIDS complicated by pulmonary R. equi infection are central ball liked high density areas in unilateral pulmonary hilus area, parenchymal changes, secondary cavities, ground glass liked changes in the lung fields, nodules and treeinbuds sign, which are characteristic rather than specific.

     

64例儿童尸检病理与临床诊断对比分析

作者收集了我院23年来资料较为完整的64例,6岁以下少年儿童尸检病例,就病理诊断与临床诊断进行对比分析。临床与病理诊断符合率为78.1％,误诊率为21.9％,分析了临床误诊和尸检率较低的原因,强调尸检在现代医学中的重要意义。     

钦州市钦南区2011-2015年HIV/AIDS病例检测晚发现影响因素分析

目的 分析钦州市钦南区2011-2015年艾滋病病毒感染者/艾滋病病例检测晚发现的影响因素,为艾滋病防控工作提供科学依据.方法 从钦州市钦南区疾病预防控制中心的国家艾滋病综合防治数据信息专报系统,导出2011-2015年HIV/AIDS病例检测数据信息.按照我国使用的晚发现定义标准,分析不同情况下的晚发现比例及影响因素.结果 2011-2015年钦州市钦南区艾滋病病毒感染者/艾滋病病例检测晚发现比例分别为41.6％、42.1％、46.8％、50.0％和45.5％;晚发现比例最高的人群分别是男性(48.4％)、50～59岁组(50.9％)、文盲及小学(46.8％)、离异或丧偶(52.4％)、海员及长途驾驶员(52.6％).不同性别、年龄、婚姻和职业间晚发现比例的差异均有统计学意义(P＜0.001);异性传播途径感染病例的晚发现比例为46.7％,明显高于其他传播途径(P＜0.001);不同样本来源的病例中,其他就诊检测晚发现比例为58.6％,明显高于其他样本来源(P＜ 0.001).结论 钦州市钦南区艾滋病病毒感染者/艾滋病病例检测晚发现比例高于全国同期水平,影响因素是多方面的综合性的,亟需进一步研究和探索科学的行之有效的健康教育和健康促进的策略,让更多有高危行为的人群自觉早期检测.     

肝脏上皮样血管内皮瘤临床影像特征（附15分析）

目的：总结分析我院肝脏上皮样血管内皮瘤（HEHE）的临床特点、影像学表现特征及预后情况,提高对该病的认识及术前诊断水平。方法：收集并分析自1999-2010年上海东方肝胆外科医院经病理证实的15例肝脏上皮样血管内皮瘤的临床影像学资料（包括CT、MRI表现）。结果：本组肝脏上皮样血管内皮瘤大部分未表现出典型的临床症状,只有7例感腹部不适。实验室检查亦无明显特异性,8例肝功能显示白球比降低,3例轻度贫血,1例谷丙转氨酶升高,所有病例AFP、CEA以及CA19-9均在正常水平;CT及MRI表现特征：大部分病例CT平扫表现为多发性不均匀低密度病灶,增强动态扫描显示动脉期肿瘤周边强化、门脉期周边进一步强化,延时扫描病灶可为环形强化;MRI T1加权像病灶为低信号,病灶中心信号更低。T2加权像病灶表现为稍高信号,病灶中心往往信号更高,增强扫描表现为环形强化,中心无明显强化,延迟期病灶进一步强化。预后情况：15例病人中有10例至今存活,其中包括4例带瘤生存。结论：认识肝脏上皮样血管内皮瘤的临床特点及影像学表现特征,了解其低度恶性的生物学特性,对于提高该病的认识和术前诊断水平以及积极的外科治疗,具有重要意义。     

AIDS合并播散性马尔尼菲青霉菌病的腹部超声影像学研究

目的探讨艾滋病合并播散性马尔尼菲青霉菌病(PSM)的腹部超声影像学特点。方法比较86例艾滋病合并PSM患者与90例艾滋病非合并PSM患者的腹部超声影像学资料。结果两组患者的年龄、性别差异均无统计学意义(P0.05)。86例艾滋病合并PSM患者腹部超声检查发现:肝脏肿大46例,占53.49%,脾脏肿大53例,占61.63%,肝脾均肿大32例,占37.21%,腹腔淋巴结肿大15例,占17.44%,腹水8例,占9.30%;而90例艾滋病非合并PSM患者的腹部超声显示:肝脏肿大12例,占13.33%,脾脏肿大25例,占27.78%,肝脾均肿大8例,占8.89%。腹腔淋巴结肿大3例,占3.33%;腹水2例,占2.22%。两组肝脏肿大、脾脏肿大、肝脾均肿大、腹腔淋巴结肿大差异均有统计学意义(P0.01),腹水差异无统计学意义(P0.05)。结论肝脾肿大、腹腔淋巴结肿大可能为艾滋病合并PSM特征之一。     

肝纤维化MR弥散加权成像与病理的对照研究

目的 探讨肝纤维化时MR弥散加权成像(MR-DWI)中表观弥散系数(ADC)值的变化规律及其病理基础.方法 使用腹腔注射CCl4法建立兔肝纤维化模型并进行MR-DWI检查.弥散敏感梯度值b=600 s/mm~2.测量ADC值,比较不同肝纤维化分期时ADC值,变化规律,并与光镜及电镜下病理改变进行对照分析.结果 随肝纤维化分期进展,ADC值逐渐下降(P<0.05);病理学表现为肝内纤维基质数量增多、范围扩大,肝组织炎症反应逐渐加重.结论 随肝纤维化分期进展ADC值下降,可能为肝内纤维沉积增多及细胞内外水分子弥散异常限制水分子运动所致.

Abstract：

Objective To investigate the alteration of apparent diffusion coefficient (ADC) in diffusion-weighted MR imaging (MR-DWI) of liver fibrosis and its pathological basis in rabbits. Methods Five rabbits in the control group and 22 with experimental liver fibrosis induced by transperitoneal injection of carbon tetrachloride (CCl4) were examined with MR-DWI. Diffusion-weighted SE EPI sequence with a relatively high b factor (b=600 s/mm~2) was used to measure the ADC. The mean values of ADC were compared among the rabbits in different stages of liver fibrosis and analyzed in relation to the pathological findings. Results The mean ADC value decreased significantly with increased severity of liver fibrosis (P<0.05). Pathologically, the amount and extension of fibrotic matrix increased, and the hepatic necroinflammation worsened with the progression of the liver fibrosis. Conclusion The ADC value decreases with the progression of liver fibrosis possibly as the result of water diffusion limitation due to increased fibrous tissue in the liver and abnormal water diffusion within the intracellular and extracellular spaces.     

中药扶正逐毒丸治疗8例艾滋病患者的临床研究

目的观察中药扶正逐毒丸治疗艾滋病的临床疗效。方法予8例患者口服扶正逐毒丸,观察临床症状、CD4淋巴细胞的变化。结果治疗后患者临床症状改善,CD4淋巴细胞明显升高。结论扶正逐毒丸在改善患者临床症状、升高CD4淋巴细胞方面具有一定作用。     

化脓性肌炎8例的MR诊断

目的分析化脓性肌炎的MR表现特点,探讨MR对化脓性肌炎的诊断价值。方法回顾分析经手术及病理证实的8例化脓性肌炎的MR表现并进行总结。结果 8例MR显示受累肌肉弥漫性肿大,T2WI上表现为较明显不均匀高信号,STIR上为明显高信号;而TlWI上呈与邻近肌肉等、略低或略高信号改变,邻近肌间隙水肿。4例病灶中见单个或多个TlWI低信号、T2WI高信号脓肿形成,周围脓肿壁在T1WI上为相对高信号。增强扫描受累肌肉呈明显弥漫性强化2例,2例脓肿形成者呈环状强化,脓腔及小的炎性坏死区无强化。结论 MR可清晰显示化脓性肌炎病变部位、特点及范围,具有重要的诊断价值。     

肾上腺肿瘤112例的影像学诊断与临床治疗

目的:评价各种影像学检查方法诊断肾上腺肿瘤的临床价值,并总结肾上腺肿瘤的外科治疗经验.方法:收集1988年5月至2000年8月期间我院收治的112例肾上腺肿瘤患者临床及影像学资料,用比较影像学方法,对各种影像学检查方法的定位、定性诊断正确率进行对比分析,并对患者的临床资料作进一步分析.结果:(1)B超、CT、MRI术前定位诊断准确率分别为85.71%、95.54%和98.14%,定性诊断准确率分别为33.33%、65.69%和79.63%;综合影像检查组定位和定性诊断准确率则高达100%及86.92%.(2)12年内成功切除肾上腺肿瘤102例,其中巨大肾上腺肿瘤(体积＞10.0 cm×5.0 cm×4.0 cm)30例;3例肾上腺转移癌在超声引导下进行局部穿刺硬化治疗;6例肾上腺转移癌采取介入性治疗;1例因经济原因而未手术.结论:(1)B超可作为肾上腺肿瘤的筛选手段,CT、MRI对肾上腺肿瘤的定位诊断正确率高,综合影像学检查可明显提高肾上腺肿瘤的诊断正确率.(2)手术切口的正确选择是手术取得成功的前提,对解剖结构的熟悉和灵巧的手术操作是取得手术成功的关键;围手术期的充分准备是减少术后并发症的保证.