新型隐球菌肺炎的临床、X线胸片与多层螺旋CT的分析

摘要

Purpose To explore the clinical manifestation and imaging findings of pulmonary cryptococcosis.Materials and Methods The clinical data, chest X-ray film and multi-slice spiral CT (MSCT) findings of 16 cases of PC were retrospectively analysed.Results Sixteen cases of PC had mild clinical symptoms, such as cough, sputum, wheezing, thoracodorsal pain and low fever.Among the 16 cases, 2 was accompanied with diabetes and 4 combined with tuberculosis.13 cases were confirmed by fibroptic bronchoscopy, and 3 cases confirmed by percutancous cutting needle biopsy (PCNB).The main signs of chest X-ray were nodular, mass and Sheet-block consolidation shadow in bilateral middle and lower lung fields, cavity in 6 cases.MSCT findings reveal that the distribution and shape of the nidus in the lungs were similar to chest X-ray; Halo signs were in 8 cases, air bronchogram in 9 cases, multiple cavity in 11 cases, and mild mediastinal lymphadenopathy in 5 cases.Most lesions of 16 cases were located in the middle or lower lungs ,which were merged with some lesions in the top lung in 4 cases.Conclusions Clinical symptoms are usually incompatible with imaging findings of pulmonary cryptococcosis.MSCT can provide more information than chest x-ray.The correct diagnosis depends on histopathologic by fiberoptic bronchoscopy and PCNB examination.%目的 探讨新型隐球菌肺炎的临床及影像学表现.资料与方法 回顾性分析16例新型隐球菌肺炎患者的临床、胸部X线片及多层螺旋CT表现.结果 16例新型隐球菌肺炎患者临床症状较轻,表现为不同程度的咳嗽、咳痰、气喘、胸背痛和低热;具有糖尿病史2例,肺结核病史4例.纤维支气管镜活检证实13例,CT定位穿刺活检证实3例.X线胸片表现为双中下肺野内结节状、肿块状及片块状实变阴影;实变影内空洞6例.多层螺旋CT显示肺内病灶分布、形态与胸片类似;"晕征"8例,支气管充气征9例,多发空洞11例,纵隔淋巴结轻度增大5例;病灶大部位于双中下肺,合并上肺病灶4例.结论 新型隐球菌肺炎的临床症状与影像表现通常不符.多层螺旋CT比X线胸片提供更多信息,确诊有赖于纤维支气管镜或穿刺活检病理证实.