艾滋病纵隔肺门淋巴结病变的CT诊断及鉴别诊断

The CT findings of thoracic lymphadenopathy in patients with acquired immunodeficiency syndrome： spectrum of disease and differential diagnosis

目的研究艾滋病（AIDS）机会性感染及相关肿瘤累及纵隔肺门淋巴结的CT表现及其鉴别诊断。方法回顾性分析668例AIDS累及纵隔肺门淋巴结患者中经病理、病原学证实的178例患者的胸部CT表现，其中49例行胸部增强扫描，119例行腹部扫描，对CT征象行χ2检验。结果178例中AIDS合并播散性马尔尼菲青霉菌病117例，结核42例，播散性隐球菌病10例，非结核分枝杆菌病5例，卡波西肉瘤3例，淋巴瘤1例。纵隔肺门淋巴结CT平扫表现为均匀软组织密度140例，中央低密度或不均匀低密度29例，均匀极低密度9例；其中49例行胸部CT增强扫描，均匀强化28例，环状强化19例，无强化2例；伴发CT征象中肺弥漫粟粒结节45例，类原发综合征13例，肠系膜淋巴结肿大（三明治征）31例，胸腔积液59例，心包积液24例。马尔尼菲青霉菌病与结核间经χ2检验，差异有统计学意义的淋巴结CT征象是均匀软组织密度、中央低密度或不均匀低密度、均匀强化、环状强化（χ2值分别为32．62、43．82、12．13、15．72，P值均〈0．05）；差异有统计学意义的伴发CT征象是肺弥漫粟粒结节、类原发综合征、肠系膜淋巴结肿大（三明治征）、胸腔积液（χ2值分别为11．76、11．06、5．44、4．07，P值均〈0．05）。结论AIDS纵隔肺门淋巴结病变可见于各种机会性感染及相关性肿瘤，CT对其诊断及鉴别诊断有重要意义。

Objective To evaluate the etiology and CT features of thoracic lymphadenopathy in patients with acquired immunodeficiency syndrome （AIDS） . Methods CT features of thoracic lymphadenopathy in 178 AIDS patients were retrospectively analyzed. Results Of 668 AIDS patients with thoracic lymphadenopathy, 174 were proved to be infections including Penicilliosis marneffei （n = 117 ）, tuberculosis （ n = 42） , cryptoeoeeosis （ n = 10） and non-tuberculous mycobaeteria （ n = 5 ）. Four were proved to be tumors including 3 Kaposi＇s sarcomas and 1 lymphoma. The enlarged mediastinal and hilar lymph node presented as homogeneous soft-tissue density in 140 patients, with central low attenuation in 29 patients, as extreme low attenuation in 9 patients on plain CT scan and showed homogeneous enhancement in 28 patients, rim enhancement in 19 patients, non enhancement in 2 patients on enhanced CT scan. Accompanied CT findings included diffuse pulmonary micro-nodules （ n = 45 ） , primary complex or similar primary complex （n = 13 ） , pleural effusion （n = 59 ） , pericardial effusion （n = 24 ）, sandwich sign in the small bowel mesentery （ n = 31 ）. The CT findings of penieilliosis marneffei and tuberculosis were compared with ehi- square test. There were significant differences on homogeneous soft-tissue density, central low attenuation, homogeneous enhancement, rim enhancement, diffuse pulmonary micro-nodules, primary complex or similar primary complex, sandwich sign, pleural effusion （χ2 = 32.62,43.82,12. 13,15.72, 11.76,11.06,5.44, 4. 07,P 〈 0. 05 ）. Conclusions Thoracic lymphadenopathy can be caused by infections and tumors in AIDS. CT plays an important role for the differential diagnosis.