老年患者继发性肺真菌病的CT表现(附36例分析)

Computed tomography findings of secondary pneumonomycosis in elderly patients(analyses of 36 cases)

目的通过对老年患者继发性肺真菌病的CT表现进行分析,评价CT对老年人肺真菌病的诊断价值。方法对36例经手术、穿刺病理证实的老年患者继发性肺真菌病的CT表现进行分析,观察病变形态、分布、边界、密度和病灶大小等特点,并分析影像与病原菌的关系。结果 36例老年患者继发性肺真菌病致病菌分别为曲霉菌18例,毛霉菌8例,隐球菌6例,白色念珠菌3例,放线菌1例。CT表现为肺叶(或肺段)实变9例,单发或多发结节或肿块9例,其中6例结节边缘见晕征;空洞8例,霉菌球6例,斑片影3例,粟粒影1例。所有病例均有胸膜反应,8例有胸腔积液。结论老年患者继发性肺真菌病影像学表现缺乏特异性,CT可确诊特征性的肺曲菌球,对表现不典型者应密切结合临床,最终诊断依靠病理学检查。

Objective To appraise the diagnostic value of computed tomography （CT） for secondary pneumonomycosis in elderly patients by analyzing the size and other features of focuses including the relationship of image expression and patho- gens. Methods The CT findings of 36 elderly patients with secondary pulmonory fungal diseases proved by surgery or bi- opsy were analized, including the morphology, distribution, border, density and size of the diseases, and the relationship between the CT findings and the pathogenic bacteria was analized too. Results The pathogens for 36 cases of secondary pneumonomycosis were aspergillus （18 cases）, Mildew （8 cases）, Cryprococcus （6 cases）, Candida albicans （3 cases）, and actinomycetes （1 case）, respectively. TheCT showed the consolidation of pulmonary lobes （or pulmonary scgmems） from 9 cases, single or multiple nodules from 9 cases （6 cases showing halo sign around nodules）, caverns from 8 cases. mould spheres from 6 cases, shadow plaques from 3 cases, and miliary shadow from 1 case. All the cases displayed pleura reaction, with 8 cases having pleural effusion. Conclusion No specificity in the CT imaging expression of secondarypneu- monomycosis in elder people was found, with CT known as a definite diagnostic tool for aspergillus, and for the ones with atypical representation, the combination with clinical expressions was needed, and the definite diagnosis was still based on the pathological examination.