白血病患者骨髓移植术后肺部并发症的CT诊断

目的探讨白血病患者骨髓移植术后肺部并发症的CT诊断。方法对30例白血病患者骨髓移植术后肺部并发症的CT表现进行回顾性分析。结果巨细胞病毒性肺炎可以表现为弥漫性实变、多发结节、毛玻璃改变、多发小片状影,以弥漫性实变为最多见(37.5%,3/8);真菌性肺炎主要表现为单发球形病灶(50.0%,4/8),其中3例病灶周围可见毛玻璃密度影;细菌性肺炎主要表现为单发片状影(50%,1/2);急性呼吸窘迫综合征(ARDS)主要表现为弥漫性实变(66.7%,2/3);肺水肿主要表现为支气管血管束增粗或网格状改变(66.7%,2/3);药物毒性反应可表现为弥漫性实变(50.0%,1/2)或网格状改变(50.0%,1/2);细支气管闭塞并机化性肺炎气管炎(BOOP)表现为多发结节状改变(50.0%,1/2)或毛玻璃密度改变(50.0%,1/2)。移植后3周内发生率最高的为真菌感染,移植后3~14周发生率最高的为巨细胞病毒性肺炎,移植后14周以后病例较少,主要为BOOP。结论综合分析CT表现对血病患者骨髓移植术后肺部并发症的诊断有较高价值。

The CT diagnosis of lung diseases after bone marrow transplantation for leukemia

Objective:To investigate diagnostic value of lung diseases after bone marrow transplantation for leukemia.Methods:The CT findings of lung disease after bone marrow transplantation for leukemia were studied retrospectively.Results:The CT findings of cytomegalovirus pneumonia included diffuse consolidation (37.5%,3/8), multiple nodules, ground-glass opacity and multiple patchy shadows. The most common CT findings of fungal pneumonia was single sphere-like lesion (50.05%,4/8), 3 cases had ground-glass opacity around them. The most common CT findings of bacterial pneumonia was single patchy shadows (50%,2/4). The most common CT finding of acute respiratory depress syndrome (ARDS) was diffuse consolidation (66.7%,2/3). The most common CT finding of lung edema was enlargement of bronchovascular bundle or reticular changes (66.7%,2/3). The most common CT finding of drug toxicity was diffuse consolidation (50.0%,1/2). The CT findings of bronchiolitis obliterans with organzing pneumonia (BOOP) were multiple nodules (50.0%,1/2) or diffuse consolidation (50.0%,1/2). During first 3 weeks after bone marrow transplantation, fungal pneumonia were the majority; the 3 weeks to 14 weeks, cytomegalovirus pneumonia predominated, 14 weeks after bone marrow transplantation few cases occurred and BOOP was most common.Conclusion:The comprehensive analyses of the clinical and CT findings are very helpful in diagnosis of lung diseases after bone marrow transplantation for leukemia.