探讨恶性血液病患者常见真菌菌株肺感染的CT表现

发布时间：2018-03-09 19:27

本文选题：血液学　切入点：肿瘤　出处：《天津医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:在结合患者临床症状和体征基础上,着重分析、归纳不同真菌菌株肺部感染的CT征象,以提高诊断水平。方法:收集2013年2月至2014年12月我院临床资料完整、基础病为恶性血液病并继发肺部真菌感染病例共128例,其中包括曲霉菌51例、毛霉菌5例、隐球菌8例、白色念珠菌44例、卡氏肺孢子菌20例。初诊及治疗后均行TOSHIBA16排螺旋CT胸部10mm层厚扫描并1mm层厚薄层重建,获得并分析CT图像,分析内容包括病灶的类型、形态、数目、累及范围、分布、边缘、内部特征及周围改变,并对治疗前、后影像学表现进行比较。结果:不同真菌菌株肺感染CT特征:(1)曲霉菌肺炎:病灶以结节样实变为主,斑片、肿块、片状实变次之,好发于胸膜下,多为多发、散在病灶,晕征、壁结节、空气新月征出现率较高,偶可见反晕征;可以伴有胸膜粘连、胸腔积液、纵膈淋巴结肿大;未见成簇或融合,罕见小叶间隔增厚、肺组织牵拉等。(2)毛霉菌肺炎:胸膜下边界模糊、边缘毛糙的结节、肿块、片状实变最多见,常多发、散在,部分可见分叶,可以有壁结节及空洞,晕征及反晕征出现率比较高,胸膜粘连多见,常有胸腔积液,可有纵膈肿大淋巴结。(3)隐球菌肺炎:胸膜下为好发部位,病灶以结节、肿块样实变为主,边缘常不规则,可呈分叶状,实变内空洞多见,部分病灶有融合趋势,未见壁结节及空气新月征,也可表现为树芽及粟粒样血行播散样改变。(4)白色念珠菌肺炎:均为多发病灶,形态多样,可以表现为斑片、结节、索条、片状实变、磨玻璃密度、树芽及粟粒等,并常常共存,可以见到晕征,实变内可见不规则空洞,未见壁结节及空气新月征出现,可伴发多脏器感染。(5)卡氏肺孢子菌肺炎:病灶以弥漫性磨玻璃密度为主,病变区内可见小叶中心性或腺泡结节样影、斑片状实变、网状影和索条影,部分病例可见融合的片状实变,亦可见到气囊,均为两肺叶同时受累,部分病例胸膜下较少累及,胸腔积液、胸膜粘连、纵膈重大淋巴结少见,未见壁结节、空洞、反晕征。结论:本组病例不同菌株肺部真菌感染的CT表现各具特征性,CT在常见真菌肺感染中有重要的实用价值。
[Abstract]:Objective: based on the clinical symptoms and signs of the patients, the CT signs of pulmonary infection of different fungal strains were summarized in order to improve the diagnostic level. Methods: from February 2013 to December 2014, the clinical data of our hospital were collected. There were 128 cases of malignant hematopathy and secondary pulmonary fungal infection, including 51 cases of Aspergillus, 5 cases of Mucor, 8 cases of Cryptococcus, 44 cases of Candida albicans. Twenty cases of Pneumocystis carinii were examined and treated with TOSHIBA16 slice spiral CT (10 mm slice thickness of chest and 1 mm slice thickness reconstruction). The CT images were obtained and analyzed, including the type, shape, number, range, distribution and edge of the lesions. Results: Ct features of pulmonary infection of different fungal strains were compared with CT features of aspergillus pneumoniae. It usually occurs under the pleura, and is mostly multiple, with a high occurrence rate of lesion, halo sign, wall nodule and air crescent sign. It may be accompanied by pleural adhesion, pleural effusion, mediastinal lymphadenopathy, no clustering or fusion. Rare lobular septal thickening, lung tissue pulling, etc.) Mycobacterium pneumoniae: subpleural border is blurred, edge rough nodules, masses, flaky consolidation is most common, often multiple, scattered, some lobes can be seen, can have wall nodule and cavity, The occurrence rate of halo sign and anti-halo sign is high, pleural adhesion is more common, pleural effusion is often seen, and mediastinal enlargement lymph node. 3) Cryptococcus pneumonia: subpleural is the predilection place, the focus is nodule, mass like consolidation, the margin is often irregular, It can be lobulated, with more solid cavity, some lesions have fusion trend, no wall nodule and air crescent sign, also can be shown as tree bud and miliary blood dispersal change. 4) Candida albicans pneumonia: all the lesions are multiple lesions, and the morphology is various. They can be seen as plaques, nodules, cord strips, flake consolidation, ground glass density, tree buds and millet grains, and often coexist. Halo signs can be seen, irregular cavities can be seen in solid changes, and no wall nodule or air crescent sign can be seen. Pneumocystis carinii pneumonia may be accompanied by multiple organ infection. The focus is mainly diffuse glass-grinding. Central lobular or acinar nodular shadow, patchy consolidation, reticular shadow and stripe shadow can be seen in the lesion area. In some cases, there were flake consolidation of fusion, and airbags, both of which were involved in both lobes at the same time. Some cases had less involvement under the pleura, pleural effusion, pleural adhesions, mediastinal major lymph nodes, no wall nodule, cavity, etc. Conclusion: the CT findings of different strains of pulmonary fungal infection have important practical value in common fungal pulmonary infection.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R733;R519;R730.44

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