【摘要】 目的探讨免疫功能无异常的原发性肺隐球菌病患者 CT 征象及 CT 引导下经皮肺穿刺活检在诊断中的价值。方法回顾性分析浙江大学医学院附属邵逸夫医院经病理证实的12例原发性肺隐球菌病患者的临床资料。结果 (1)12例患者的 CT 征象均为单肺叶发病,其中单发结节4例,局限性多发混杂的结节和(或)肿块和(或)肺实变8例,此外还可见支气管充气征/小泡征(9例)、空洞(2例)和“晕”征(4例)。(2)9例行 CT 引导下经皮肺穿刺活检,其中7例病理学确诊。(3)12例患者中7例行手术切除,术后2例行氟康唑治疗,余5例未用药,其中1例术后5个月发生隐球菌性脑膜炎;另5例用氟康唑治疗。结论免疫功能无异常者时有发生肺隐球菌病的可能;肺隐球菌病的临床症状与影像学表现明显不相称;大多数肺隐球菌病的 CT 主要征象为局限性多发混杂的结节和(或)肿块和(或)肺实变,如同时有支气管充气征/小泡征、晕征,则具有特征性;尽早采用CT 引导下经皮穿刺活检将有助于该病的早期诊断;氟康唑治疗该病效果好,有助于预防严重并发症的发生。更多还原

【Abstract】 Objective The purpose of this study was to analyze the chest CT findings of immunocompetent patients with primary pulmonary cryptococcosis and to evaluate the utility of CT-guided percutanous biopsy in the diagnosis.Methods Chest CT scans of 12 immunocompetent patients with biopsy-proven primary pulmonary cryptocococsis were analyzed for the number of lesions,morpbologic characteristics,distribution of parencbymal abnormalities,and the presence of lymphadenopathy and pleural effusion.Lung specimens were obtained by CT guided percutaneous biopsy(n=9)and/or surgical resection (n=7).A pulmonary pathologist reviewed the specimens.Results The main manifestations were classified into two patterns.Localized multiple mixed lesions(nodules and/or masses and/or consolidation)were found in 67%(8/12)of the cases,and single nodules were found in 33%(4/12).Associated findings included air bronchograms(n=9),cavity(n=2),and CT halo sign(n=4).Lung specimens were obtained by CT guided percutaneous biopsy in 9 cases,of which 7(78%)were confirmed by pathology. Seven cases recovered after treatment with fluconazole,but cryptococcal meningitis occurred in 1 case 5 month after single excision.Conclusions Chest CT findings of primary pulmonary cryptococcosis in immunocompetent patients have a predominant pattern of localized multiple mixed lesions.CT guided percutaneous biopsy is helpful in confirming the diagnosis.Fluconazole is effective in the treatment of pulmonary cryptococcosis in these patients.更多还原