免疫正常患者肺隐球菌病的CT征象分析

目的 研究免疫正常患者肺隐球菌病的CT表现。 方法 回顾分析台州恩泽医院2014年9月-2016年9月经病理确诊的32例无基础疾病及免疫缺陷肺隐球菌患者的临床资料和CT表现。 结果 32例肺隐球菌患者中,结节/肿块型24例(75.0%),实变型7例(21.9%),混合型1例(3.1%)。结节/肿块型中单发16例(66.7%),多发8例(33.3%);实变型中单发1例(14.3%),多发6例(85.7%)。15例多发病例中,单肺叶分布占据66.7%(10例)。所有患者共检出69个可评估病灶,其中周围型分布占据66.7%(46个),下肺区分布占50.7%(35个)。48个结节/肿块病灶中空气支气管征发生率为62.5%(30个),其中Ⅲ型为18个(ⅢA型13个,ⅢB型5个),Ⅴ型10个,Ⅳ型2个,未见Ⅰ/Ⅱ型;晕征、分叶、毛刺、空洞及胸膜改变发生率分别为41.6%、29.2%、16.7%、12.5%、25.0%。21个实变病灶中,晕征发生率为85.7%(18个),胸膜增厚发生率为76.2%(16个),空气支气管征发生率为81.0%(17个),其中ⅢA型3个,ⅢB型12个,Ⅴ型2个,未见Ⅰ/Ⅱ/Ⅳ型;空洞发生率38.1%(8个)。 结论 免疫正常患者肺隐球菌病好发于下叶胸膜下,以单发结节/肿块型为主,ⅢA型、V型空气支气管征是其主要特征;而ⅢB型空气支气管征是实变型病灶的特征表现。 

CT findings of pulmonary cryptococcosis in immunocompetent patients

Objective To analyze the CT findings of pulmonary cryptococcosis in immunocompetent patients. Methods CT features and clinical data of 32 immunocompetent patients with histopathologically-proven pulmonary cryptococcosis were retrospectively and analyzed. Results Of the 32 immunocompetent patients, there were mass/nodule pattern(75.0%, n=24), pulmonary consolidation pattern(21.9%, n=7) and the mixed type(3.1%, n=1). In mass/nodule pattern, the occurrence rate of single solitary mass/nodule was 66.7%(n=16), and the multiple mass/nodule was 33.3%(n=8);in pulmonary consolidation pattern, the occurrence rate of single solitary was 14.3%(n=1), and the multiple was 85.7%(n=6). Of all the 15 multiple patients, the occurrence rate of unilateral lobar distribution was 66.7%(n=10). In all sixty-nine measurable lesions, the peripheral distribution(66.7%, n=46) and lower pulmonary distribution (50.7%, n=35) were seen more. In 48 mass/nodule pattern, the occurrence rate of air-bronchogram sign was 62.5%(n=30), include ⅢA(n=13), ⅢB(n=5), Ⅴ(n=10), Ⅳ(n=2), without Ⅰ/Ⅱ;Other findings included halo sign (41.6%), lobulation sign(29.2%), spicule sign(16.7%), cavity or vocule sign(12.5%) and pleural change(25.0%). In 21 pulmonary consolidation pattern, the CT findings included halo sign(85.7%, n=18), pleural incrassation sign(76.2%, n=16), cavity or vocule sign(38.1%, n=8) and air-bronchogram sign(81.0%, n=17), include ⅢA(n=3), ⅢB(n=12 patients), Ⅴ(n=12), without Ⅰ/Ⅱ/Ⅳ. Conclusion The pulmonary cryptococcosis in immunocompetent patients usually occurs in lower lobe near pleural, the mass/nodule pattern is the prevalent CT manifestation, the air-bronchogram sign(type ⅢA, Ⅴ) is the most common CT finding;the air-bronchogram sign(type ⅢB) is the characteristic findings of CT manifestationgs in pulmonary consolidation pattern.