肺部真菌感染的CT诊断及鉴别诊断

目的探讨CT诊断及鉴别诊断对肺部真菌感染的价值。方法回顾性分析31例肺部真菌感染患者CT检查资料和病历资料。结果病灶以多发结节影为主要表现者5例,均为隐球菌感染,其中2例病灶周围可见晕轮征;以单发结节、肿块或空洞影为主要表现者10例,其中5例为曲霉菌感染,3例为毛霉菌感染,2例为隐球菌感染,5例肿块周围可见晕轮征,6例肿块伴有内壁光滑的空洞;以磨玻璃影为主要表现者7例,其中4例为念珠菌感染,2例为毛霉菌感染,1例为卡氏肺孢子菌病;以肺部实变影为主要表现者9例,其中4例为假丝酵母菌感染,5例为毛霉菌感染,表现为肺内片状或不规则形高密度影,内部密度不均,可见充气支气管征,增强扫描无或轻度强化。3例伴有肺门淋巴结肿大,2例伴有胸腔积液。结论肺部真菌感染CT表现除霉菌球外,其余复杂多样,缺乏特征性,诊断时除影像学方面注意与其他疾病鉴别外,还要密切结合临床,必要时采取穿刺活检、纤维支气管镜检查等方式明确诊断。

CT Diagnosis and differentiation of pulmonary fungal infection

Objective To investigate the value of CT diagnosis and differentiation of pulmonary fungal infection. Methods The clinic datas of CT examination information and medical records of 31 patients with pulmonary fungal infection were analyzed retrospectively. Results Multiple nodular shadows were mainly characterized in 5 cases and with cryptococcal infection,in which 2 cases with visible lesions around the halo sign.Single nodule,lumps or empty shadow were mainly characterized in 10 cases,in which 5 cases were aspergillus infection,3 cases were mucor infection, 2 cases were cryptococcal infection,visible around the bump halo sign were in 5 cases,tumor with smooth inner wall of hollow was in 6 cases.The main performance of lesions in 7 cases was grinding glass shadow,in which candida infec- tion was shown in 4 cases,there was mucor infection in 2 cases,1 case was cartesian pneumocystis disease.There were 9 cases with consolidation of the lung shadow, in which 4 cases with candida yeast infection,5 cases with mucor infec- tion,it was characterized by the lungs flake or irregular shape high density shadow,internal uneven density,air bron- chogram,there was no or mild reinforcement in enhanced scan.There were three patients with the lung lymph node en- largement,2 patients with pleural effusion. Conclusion The presentation of pulmonary fungal infection in CT was com- plex and diverse,with lack of characteristic diagnosis excect the mold ball,it is diagnosed not only need to pay attention to the differentiation between iconography and other diseases,but also combined with clinical closely,when it is neces- sat/to clarify a diagnosis by bronchoscopy,biopsy,and so on.