并殖吸虫病患者不同临床时期的胸部CT表现及其临床意义

The manifestations and clinical significance of chest CT in paragonimiasis at different clinical phases

目的探讨并殖吸虫病不同临床时期的胸部CT表现及其临床意义。方法收集2000年11月至2007年12月上海市肺科医院实验室检查证实为并殖吸虫病的患者48例，男30例，女18例。年龄9～66岁，平均31．4岁。均行胸部CT平扫，部分加增强扫描。结果48例并殖吸虫病患者的胸部CT表现为支气管周围炎样改变9例；肺浸润性改变13例，胸部CT表现为单侧或双侧斑片状影，边缘模糊，部位及形态易变，少数病例可见特征性的“隧道”征；结节和肿块11例；囊状影及空洞6例；胸腔积液9例。并殖吸虫病患者不同临床阶段的胸部CT表现不同，感染早期表现为支气管周围炎样及浸润性改变，并出现胸腔积液；中期表现为结节、肿块、囊肿及空洞；稳定期表现为附壁结节、空腔、胸膜增厚或钙化。结论并殖吸虫病患者不同时期的胸部CT表现不同。并殖吸虫病的诊断需密切结合临床资料和CT表现。

Objective To investigate the chest CT manifestations of paragonimiasis at different clinical phases. Methods Forty-eight cases of paragonimiasis confirmed by laboratory studies were retrospectively analyzed. There were 30 males and 18 females aging 9 -66 years （average, 31.4 years）. Conventional chest CT was performed in all cases and contrast enhanced CT in some cases. Results The chest CT findings of paragonimiasis included ： （ 1 ） Peribroncial inflammation （ n = 9）. （2） Infiltration（ n = 13）, manifested as unilateral or bilateral patchy infiltrates with hazy borders. The location and shape were variable. The typical ＂canal gas-path＂ sign was seen in a few patients. （3） Nodular and masses（ n = 11 ）. （4） Cysts and cavity（ n = 6 ）. （ 5 ） Pleural effusion （ n = 9 ）. The CT appearances of paragonimiasis were different at different clinical phases. Peribronchial inflammation, infiltration and pleural effusion were early presentations, not distinguishable from other common infections. The appearance of nodules, masses, cysts and cavities was more common in the clinical course. At the stabilization phase, nodular cavity or pleura thickening and calcification were revealed. Conclusions There are various abnormalities on chest CT at different phases of paragonimiasis. Combination of clinical manifestations with chest CT characteristics is important in the diagnosis of paragonimiasis.