艾滋病合并马尔尼菲青霉菌感染的胸部影像学表现

The chest image appearances of penicilliosis marneffei in patients with AIDS

目的探讨艾滋病合并马尔尼菲青霉菌感染的胸部影像学表现。方法回顾性分析36例艾滋病合并马尔尼菲青霉菌感染者的胸部 X 线片+高分辨率 CT(HRCT)表现。结果 36例患者胸片中14例出现肺内浸润性病灶或局限性肺实变(38.89%),其中单肺2例(5.56%)、双肺12例(33.33%);8例呈弥漫性分布(22.22%),10例呈网织纹理(27.78%)、9例见小结节(25.00%)、7例呈磨玻璃密度影(19.44%)、6例见粟粒样病变(16.67%)、5例见肺气囊(13.89%)、4例见胸腔积液(11.11%)、4例出现肺门及纵隔淋巴结增大(11.11%)、2例见结节状肿块影(5.56%)、心包积液及自发性气胸各1例(2.78%);36例患者 HRCT 发现32例出现肺内浸润性病灶或局限性肺实变(88.89%),其中单肺4例(11.11%)、双肺28例(77.78%);13例呈弥漫性分布(36.11%)、10例见小叶间隔增厚(27.78%)、9例见小结节(25.00%)、8例呈磨玻璃样密度影(22.22%)、9例见粟粒样病变(25.00%)、8例见肺气囊(22.22%)、13例见胸腔积液(36.11%)、21例见纵隔淋巴结增大(58.33%)、2例见结节状肿块影(5.56%),心包积液及自发性气胸各1例(2.78%)。结论艾滋病合并马尔尼菲青霉菌感染者常见的胸部影像表现为:肺内多发的浸润性病灶或局限性肺实变及磨玻璃密度影,肺门或纵隔淋巴结增大,胸腔积液,肺间质病变即网织纹理(小叶间隔增厚),粟粒样病变及肺气囊。

Objective To study the chest image appearances of penicilliosis marneffei （ PSM ） in patients with acquired immune deficiency syndrome （MDS）. Methods Chest imaging features of PSM in 36 patients with MDS were retrospectively analyzed. Results Radiographic features of infiltrative lesions and focal lung consolidation were found in 14 cases （ 38. 89% ） , in which 2 cases were with single lung disease （5.56%） and 12 cases with bilateral lung involvement （33. 33% ）, Eight cases had diffuse lesions （22.22%）, 10 cases had reticular image patterns（27.78% ）, 9 cases had nodular patterns （25.00%）, 7 cases had ground-glass shadows（ 19.44% ）, 6 cases had diffuse miliary lesions （16. 67% ）, 4 cases had enlarged hilar and enlarged mediastinum lymph nodes （ 11.11% ）. Cystic lesions was found in 5 cases （13. 89% ）. Four cases had pleural effusion （ 11. 11% ） , and 2 cases had nodular bump （ 5. 56% ） . Pericardial effusion and pneumothorax each appeared in 1 case （2. 78% ）. By HRCT, infiltrative lesion and focal lung consolidation were found in 32 patients （88. 89% ） , in which 4 cases were with single lung lesions （11.11%） and 28 cases were with bilateral lung lesions （77.78%）. Thirteen cases had diffuse lesions （36. 11%）, 10 cases had pulmonary interstitial hyperplasia （27.78%）, 9 cases had nodular patterns （25.00%） , 8 cases had ground-glass shadows（22. 22% ）, 9 cases had diffuse miliary lesions （25.00%）, 21 cases had enlarged lymph nodes in the mediastinum （58.33%）. Cystic lesions were found in 8 cases （22. 22% ）. Thirteen cases had pleural effusion （36. 11% ）, and 2 cases had nodular bump（5.56% ）. Pericardial effusion and pneumothorax each appeared in 1 case （2.78%）. Conclusion The image appearances of PSM in patients with AIDS include infiltrative lesions or focal lung consolidation, groundglass shadow, enlarged hilar and mediastinum lymph nodes, pleural effusion, interstitial involvement or reticular image pattern （pulmonary interstitial hyperplasia）, diffuse miliary lesion, and cystic lesion.