免疫正常儿童肺隐球菌病的CT表现

CT findings of pulmonary cryptococcosis in immunocompetent children

目的研究免疫正常儿童肺隐球菌病的CT表现。方法回顾分析经临床确诊的21例无基础疾病及免疫缺陷肺隐球菌病患儿的临床资料和CT表现。结果免疫正常儿童肺隐球菌病肺内CT表现为左肺舌叶胸膜下直径约1mm的孤立结节1例；肺内大小不均匀多发结节20例，胸膜下及肺外带分布12例，肺内弥漫分布8例；结节直径〈10．0mm18例，其中3．0mm以下14例，〉10mm2例；结节为类圆形且边界光滑15例。淋巴结肿大17例，CT增强后3例轻度强化、2例环形强化。14例合并肝、脾、肾和中枢神经系统感染等肺外病变。随访1例患儿死亡，20例痊愈。结论免疫正常儿童肺隐球菌病以肺内多发小结节伴多组淋巴结肿大为主要的CT特征，并易合并肺外器官播散。

Objective The aim of our study was to study the CT findings of cryptoeoccosis in immunocompetent children. Methods CT scan and clinical data of 21 immunocompetent children with proven pulmonary cryptocoecosis were retrospectively collected and analyzed. Results The CT scans demonstrated 1 mm subpleural nodule in the lingula of left lung in 1 patient and multiple nodules in 20 patients. Of 20 patients with multiple nodules, peripheral or subpleural distribution was found in 12 patients, and diffuse distribution in 8 patients. Of 20 patients with multiple nodules, Nodules of 〈 l0 mm was found in 18 patients, 〈3 mm in 14 patients, and 〉 10 mm in 2 patients. Round nodular with smooth margin was detected in 15 of 20 patients with multiple nodules. Lymphadenopathy was found in 17 patients including 3 patients with mild contrast enhancement and 2 patients with circular enhancement. Extra- puhnonary lesions distributing in liver, spleen, kidney, and the nervous system were found in 14 patients. In follow-up, 1 patient died and 20 patients fully recovered. Conclusions Pulmonary multiple nodules with lymphadenopathy is the characteristic CT findings in immunocompetent children with pulmonary crytococcosis which is prone to involve multiple extra-pulmonary organs.