免疫功能低下患者肺部感染的CT表现与鉴别诊断

目的:分析免疫功能低下患者肺部感染的CT表现及鉴别诊断。方法:回顾性分析尿毒症长期血透治疗患者和肾移植术后致免疫功能低下肺部感染患者87例,分析比较CT上不同病原体的肺部感染病灶的形态、分布、密度等特征和动态变化的规律。并与病原学诊断结果对照。结果:本组87例肺部感染患者中,细菌性肺炎37例(42.53%),巨细胞病毒性肺炎14例(16.09%),卡氏肺囊虫肺炎6例(6.89%),肺结核19例(21.84%),真菌性肺炎11例(12.64%)。CT表现为弥漫性斑片状和磨玻璃样伴点状或网状阴影共20例;表现为小片状或大片状阴影41例;其他表现为散在小结节、斑片状或条状不规则阴影。结论:本组病例中以细菌性肺炎最多见,其次为肺结核。免疫功能低下患者不同肺部感染的CT表现有一定特点,巨细胞病毒性肺炎和卡氏肺囊虫肺炎主要表现为伴有肺间质增厚;细菌性肺炎和真菌性肺炎主要表现为肺实质渗出性病变;肺结核主要表现为不均匀粟粒影。CT对鉴别诊断有一定价值。

CT manifestation and differential diagnosis of pulmonary infection on patients with low immune function

Objective： To analyse CT manifestations and differential diagnosis on pulmonary infection of the patients with low immune function. Methods： Eighty seven cases of pulmonary infection after renal transplantation and long-term hemodialysis with uremia were retrospectively analyzed, including characteristics and dynamic change law, such as shape, distribution, density on different lesions, compared with etiological diagnosis. Results： In 87 cases of pulmonary infection, 37 cases were bacteria pneumonia（42.53%）, 14 eases were cytomegalovirus pneumonia（16.09%）,6 cases were Pneumocystis Carinii pnenmonia （6. 89%）,19 cases were tuberculosis（21.84 %）, 11 cases were fungal pneumonia（12.64%）. Twenty cases demonstrated diffuse, patchy, motting and translucent shadows with reticular features;41 cases showed small or big patchy lung shadows and others with small lobulated,patchy and stripe shadows. Conclusion： Bacteria pneumonia is mostly seen in these cases,tuberculosis in the next place. There were some characteristics of pulmonary infection patients with low immune function existed in CT images. Cytomegalovirus pneumonia and Pneumocystis Carinii pnenmonia（PCP）mainly showed interstitial pneumonia, bacteria and fungal pneumonia mainly demonstrated parenchyma consolidation while tuberculosis showed miliary nodules with various sizes. CT scan has a great value in differential diagnosis of puhnonary pneumonia.