肺部蠊缨滴虫感染的影像表现

The imaging manifestations of pulmonary iophomonas blattarum infection

目的探讨蠊缨滴虫肺部感染的影像表现。方法17例同种异体肾移植术后患者，术后1～4个月内出现发热，但多不伴咳嗽、咯痰、胸闷、气短等症状，X线胸片显示肺部阴影，后经纤维支气管镜和支气管肺泡灌洗液检查确诊为肺部蠊缨滴虫感染。回顾分析肺部感染期间17例X线胸片和16例胸部CT像，总结该病的常见影像表现。结果X线表现：17例患者中有16例出现累及双侧的肺部阴影，其中9例呈散在分布于双肺的点片状及条索状阴影，7例出现大片云絮状阴影，1例仅见双肺纹理增粗、紊乱；CT表现：所有16例有CT资料的患者，病灶均出现于双侧、累及2叶以上；15例出现磨玻璃样改变，11例出现片状实变影，14例出现条索样病灶，8例出现结节影。11例同时出现磨玻璃样改变、片状实变影和条索状病灶。10例出现纵隔淋巴结肿大。结论具有致机体免疫力降低诱发因素的患者，临床上出现发热而不伴咳嗽、咯痰等症状，胸部CT显示局限性分布于双肺、多叶的磨玻璃样阴影和散在分布于肺野内的片状实变影以及条索状影相伴出现，经抗生素治疗无效者，应考虑到蠊缨滴虫感染的可能。

Objective To discuss the imaging features of pulmonary lophomonas blattarum infection. Methods Seventeen patients with renal homotransplantations presented fever without cough, dyspnea and shortness of breath in 1--4 months after the transplantation were included. Chest X-ray abnormalities were comfirmed as pulmonary lophomonas blattarum infection through fiberoptic bronchoscopy （FOB） and bronchoalveolar lavage （BAL）. The X-ray and CT films were reviewed and the imaging features were summarized. Results X-ray appearances： Bilateral pulmonary shadows were seen in 16 patients,of which 9 cases presented patchy and cord shadows, and 7 cases presented large area of pathy shadows. Lung marking increase was seen in 1 case. CT appearances： CT abnormalities presented bilaterally and involved more than two lobes in all 16 patients. 15 cases displayed ground-glass opacity, 11 cases displayed patchy consolidation, 14 cases displayed bandlike attenuation, and 8 cases displayed nodular opacity. Ground-glass opacity, consolidation and baudlike attenuation were seen simultaneously in 11 cases. Lymph node enlargement in mediastinum was presented in 10 cases. Conclusion Pulmonary lophomonas blattarum infection should be suspected in immunosuppressed patients combining the CT appearances and clinical information.