肾移植术后特异性肺部感染的影像学诊断

Imaging Diagnosis of Specific Pulmonary Infection After Kidney Transplantation

【目的】探讨肾移植术后特异性肺部感染的X线及CT表现,提高对本病的诊断水平。【方法】回顾性分析肾移植术后特异性肺部感染32例,全部病例均摄有胸部X线片,其中13例同时行胸部CT检查。【结果】①巨细胞病毒性肺炎15例:12例早期胸片无改变或表现为肺纹理增粗、模糊,进而12例均表现为两肺间质性肺炎;3例直接表现为两肺间质性肺炎。②肺结核11例:6例粟粒性肺结核表现为两肺弥漫性小结节状密度增高影,5例表现为单纯片状浸润病灶。③真菌性肺炎6例:4例为肺曲霉菌病,2例表现为两肺多发片状影伴空洞形成、1例表现为多发小结节影、1例表现为单发团块状影;2例肺毛霉菌病表现为两肺弥漫性斑片状、小片状影,部分融合。【结论】肾移植术后特异性肺部感染的影像学表现多无特征性,CT扫描对早期发现病变及鉴别诊断有重要价值,影像学诊断须结合临床资料。

[Objective]To explore the X-ray and CT findings of specific pulmonary infection(SPI) after kidney transplantation and to improve the diagnosis level.[Methods]Thirty two cases of SPI after kidney transplantation were retrospectively analyzed. Chest X-ray films were taken on all patients. CT examinations were performed on 13 patients.[Results]①Fifteen cases with cytomegalovirus pneumonia:At the early stage, 12 cases were no changes or showed lung markings enhancement, then became interstitial pneumonia . The other 3 cases displayed interstitial pneumonia directly.②Eleven cases with pulmonary tuberculosis:6 cases of miliary pulmonary tuberculosis displayed diffuse small heightened density tubercle shadow in bilateral lung field. 5 cases displayed simple slice infiltrative focus.③Six cases with fungal pneumonia: 4 cases were pulmonary aspergillosis ,in which 2 cases displayed mutiple-slice shadow with cavity formation and 1 case displayed mutiple-tubercle shadow and 1 case displayed single conglomerate shadow . 2 cases of pulmonary mucormycosis displayed diffuse spot slice and small slice shadow with partial fusion.[Conclusion]Usually the imaging finding of SPI after kidney transplantation has nothing characteristic.CT scan has an important value in finding focuses at early stage and in differentiated diagnosis.The imaging diagnosis should correlate with clinical data.