肾移植术后巨细胞病毒性肺炎的X线表现及误诊原因

X-ray findings and misdiagnosed causes of cytomegalovirus pneumonia in renal transplantation recipients

目的分析肾移植术后患者合并巨细胞病毒肺炎的X线征象及误诊原因。方法对12例包括4例误诊为其他疾病的肾移植术后合并巨细胞病毒肺炎患者的X线表现进行回顾分析。结果12例巨细胞病毒肺炎患者,2例无明显肺部改变,其余10例X线改变早期为两肺野纹理增强、模糊不清、呈毛玻璃样密度增高。其中,4例肺内出现小结节病灶,2例肺内散在分布斑片样病灶。对12例巨细胞病毒肺炎患者追踪观察,7例患者发病后2d～7d肺内不同程度出现新斑片样病灶。4例患者早期X线误诊为肺间质水肿、粟粒性肺结核、肺霉菌病以及肺部感染各1例。本组X线误诊率为33%。结论肾移植术后患者早期出现上述肺部改变,应综合分析并考虑巨细胞病毒肺炎的可能。

Objective to analyze the X - ray findings and misdiagnosed causes of cytomegalovirus pneumonia after renal transplantation. Methods X - ray lindings of 12 patients with cytomegalovirus pneumonia after renal transplantation who included misdiagnosed 4 cases were analyzed retrospectively. Results On X - ray chest films of 12 patients, 2 cases were found to be indefinite pulmonary change while other 10 cases in whose both sides of the lung field presented lung markings increasing and ground glass dense shadows. Of them, 2 cases were found to be intrapulmonary small nodular shadows , 2 cases to be intrapulmonary scattered patchy lesions. Followed - up observation of all patients shown that, 7 cases appeared more or less new patchy lesions at 2 to 7 days after pathogenesis. 4 cases were misdiagnosed as pulmonary interstial edema, miliary tuberculosis, pulmonary aspergillosis and pulmonary infection, respectively. Conclusion When patients who underwent renal transplantation present above pulmonary changes , it is necessary to perform an overall analysis and to consider the possibility of cytomegalovirus pneumonia.