34例肺真菌病的临床影像学表现

目的：加深对各种肺真菌病的临床影像学认识,提高影像学诊断水平。资料与方法：对34例经手术、痰检、脑脊液培养证实的肺真菌病的临床影像学资料进行随访和回顾性分析。结果：影像学表现有：团块状球形病灶共19例（其中6例有“新月征”,4例有“空气支气管征”,3例边缘有“毛刺征”,2例有“晕征”）。两肺或一肺斑点状小结节状病灶共11例。大的肺脓肿改变1例。大片状实变1例。纵隔淋巴结增大伴胸腔或心包积液1例。结论：本病临床症状无特征性,病史有参考价值。在影像表现上球形病灶有新月征、空气支气管征、晕征对本病有提示价值,如发现半月形空洞内有随体改变的“洞中球征”,对肺曲菌病有重要诊断价值。本病的确诊需病理和细菌学检查。

Imaging Manifestations of Pneumomycosis: A Report of 34 Cases

Objective To make a further understanding of the imaging features of pneumomycosis and to improve its radiological diagnosis. Materials and Methods The imaging findings of 34 cases with pneumomycosis were retrospectively analyzed. The diagnosis in all cases was confirmed by surgery, sputum exam and cerebrospinal fluid culture for fungus.Results The following signs were observed. (1) Spherical lesion was seen in 19 cases, of which crescent sign was demonstrated in 6, air bronchogram sign in 4, spiculate sign in 3 and halo sign in 2. (2) Mottling nodules in one or both lung fields were seen in 11 cases. (3) Lesions similar to large lung abscess were found in one case. (4) Large pulmonary consolidation was seen in one case. (5) Mediastinal lymphadenopathy with pleural and pericardial effusion was found in one case.Conclusion Pneumomycosis has no characteristic symptoms, although the illness history is of some reference value. The imaging signs, such as spherical mass with crescent, air bronchogram or halo sign, are very suggestive for the diagnosis. The presence of a movable fungal ball within a semilunar cavity, the sign of "ball in a cavity", is very helpful for making the diagnosis of aspergilloma. Pathologic and bacterial exams are needed to make a confirmative diagnosis.