肾移植后巨细胞病毒肺炎的影像学诊断

目的 探讨肾移植术后巨细胞病毒（CMV）肺炎的影像学诊断。资料与方法 搜集13例肾移植术后CMV肺炎患者的临床、实验室以及胸片和CT检查资料，对其胸片和CT表现进行回顾性分析。结果 X线胸片早期表现基本正常或仅表现两肺纹理增多模糊，其中4例在3-7d内复查胸片，病灶发展迅速，可见磨玻璃影和大片状实变影，弥漫分布于两肺野内；CT主要影像学表现有两肺弥漫分布的磨玻璃影13例，小结节影9例，斑片状实变影8例及小叶间隔增厚7例等，其中以磨玻璃影最为常见，并通常与其他影像学表现混合存在。结论 X线胸片是肾移植术后CMV肺炎最基本的检查方法。CMV肺炎的影像学表现，尤其CT表现具有一定特点，结合临床可提示诊断。

Imaging Diagnosis of Cytomegalovirus Pneumonitis after Kidney Transplantation

Objective To discuss imaging diagnosis of cytomegalovirus pneumonitis after kidney transplantation.Materials and Methods Clinical, laboratory data, chest X-ray films and CT findings of 13 cases with cytomegalovirus pneumonitis after kidney transplantation were retrospectively analyzed.Results Among 13 cases, the chest X-ray films demonstrated normal, or obscure pulmonary markings only in early stage, the lesions were rapidly progressive, diffuse flake consolidation and ground glass shadows were displayed in both lungs in 4 cases after 3 to 7 days later; On CT, the main CT appearance contained diffuse ground glass shadows,flake consolidation, small nodules,thickened interlobular septum etc. The most frequent CT appearance was ground glass shadow mixed with other imaging appearances. In all 13 cases, ground glass shadows (n=13), small nodules (n=9),flake consolidation (n=8),thickened interlobular sptum (n=7) were seen.Conclusion Plain X-ray film is the elementary mean to detect cytomegalovirus pneumonitis. Imaging findings, especially CT appearances have some characteristics, associated with clinic data can suggest the diagnosis of cytomegalovirus pneumonitis after kidney transplantation.