外源性变应性肺泡炎的临床病理特征和影像学表现

目的探讨外源性变应性肺泡炎(EAA)的临床病理特征和影像学表现。方法分析5例外源性变应性肺泡炎病例的临床特点、影像学表现、肺活检的病理特征。结果 EAA常见的临床表现为咳嗽、呼吸困难、咳痰、发热;主要阳性体征为轻度紫绀、肺部听诊湿啰音或Velcro啰音;肺功能检查显示限制性通气功能障碍和弥散功能障碍。HRCT表现为磨玻璃影、小叶间隔增厚、小叶中心性结节、网格影和蜂窝肺等。支气管肺泡灌洗液显示淋巴细胞增多。肺活检组织病理学示淋巴细胞性间质性肺炎,细支气管周围可见小的不典型肉芽肿和多核巨细胞。患者对糖皮质激素治疗有效。结论临床表现结合影像学特点可提示EAA临床诊断,肺活检是诊断EAA有效的检查方法。

Clinical and pathological features and imaging manifestations of extrinsic allergic alveolitis

Objective To study the clinical and pathological features and imaging manifestations of extrinsic allergic alveolitis （EAA）. Methods 5 patients with EAA were selected in this study, and their clinical features, imaging manifestations, and pathological features were analyzed. Results The most common clinical manifestations of EAA were cough, progressive dyspnea, sputum, fever, and slight eyanosis. The main positive signs were slight eyanosis, bilateral crackles or velero rales on chest auseuhation. The primary abnor- malities of pulmonary function were restriction and reduction in diffusing capacity. The most common findings on high-resolution computed tomography （HRCT） were ground-glass opacities, interlobular septum thickening, eentrilobular nodules and reticular or honeycombing le- sions. Bronehoalveolar lavage fluid （BALF） showed lymphoeytosis. Pathologic examination of lung biopsy specimens showed lymphocytic interstitial pneumonitis, small uncharacteristic granuloma and muhinucleated giant cells surrounding the bronehioles. Cortieosteroids was effective to the patients. Conclusion Clinical diagnosis of EAA can be suggested by the clinical characteristics and typical imaging fea- tures. Video-assisted thoracoscopic lung biopsy is an effective method in the diagnosis of patients with EAA.