慢性空洞性肺曲菌病临床表现

Clinical manifestation of chronic cavitary pulmonary aspergillosis

目的探讨慢性空洞性肺曲菌病的临床症状、影像学特点、诊断和治疗方法。方法对3例误诊为肺结核而长期抗结核治疗无效，甚至导致肺毁损，经手术切除病变肺叶或经支气管肺活检术，病理确诊为慢性空洞性肺曲菌病的临床资料进行总结。结果慢性空洞性肺曲菌病常见的临床症状为慢性咳嗽、疲劳不适，严重者出现气短。影像学显示空洞出现在肺上叶，且进行性增大，有时为多发。组织学检查在空洞内可找到真菌菌丝，周围肺组织有慢性炎症和肺纤维化，伴有胸膜肥厚。结论慢性空洞性肺曲菌病是慢性肺曲菌病的一种亚型，临床上少见，常见影像学特点是肺内空洞进行性增大，组织学检查在空洞内可找到真菌菌丝，治疗上需积极抗真菌，必要时可手术。

Objective To discuss the clinical manifestation, imaging characteristic, diagnosis and treatment of chronic cavitary pulmonary aspergillosis （CCPA）. Methods Clinical data of three patients with CCPA were summarized,who had ever been misdiagnosed as pulmonary tuberculosis for a long time and failed to treatment with antituberculosis drugs, even aggravated to have lung injury, and were pathologically confirmed as CCPA by surgery or transbronchial lung biopsy. Results Chronic cough, fatigue,or short breath were common clinical symptoms of CCPA. Imaging results showed that cavitary lesions appeared in the upper lobe of lung,which increased progressively,and sometimes were multiple. Histological examination showed that fungal hyphae cound be found in the cavity, chronic inflammation and pulmonary fibrosis appeared in surrounding lung tissue, accompanying pleural thickening. Conclusions CCPA is a subtype of chronic pulmonary aspergillosis, which is rare in clinic. The imaging characteristic is mainly that cavitary lesions increase progressively. Fungal hyphae can be found in the cavity by histological examination. For CCPA patients,antifungal therapy should be taken actively, and surgery can be taken if necessary.