原发性肺部真菌病计算机断层扫描的表现

Computerized tomography findings in primary pulmonary fungal infections

目的探讨原发性肺部真菌病的CT表现。方法回顾性分析2004年至2012年收集的18例原发性真菌感染患者的CT表现及临床资料，所有患者均经病理学或血清学检查确诊。结果在18例原发性肺部真菌病患者中，15例的CT表现为软组织密度结节，3例表现为肿块。病理学或血清学检查证实，12例为曲霉菌感染，3例为新型隐球菌感染，3例为球孢子菌感染。12例曲霉菌感染者的CT表现均为类圆形病灶，可见分叶征及毛刺征6例，支气管穿过征3例，空气新月征6例，其中6例行CT增强扫描，3例无明显强化，3例轻度强化；两肺门及纵隔淋巴结肿大3例。6例出现空气新月征者均为曲霉菌感染。新型隐球菌感染的CT表现均为菜花状病灶，可见分叶及毛刺征，内无钙化灶；CT增强扫描均表现为部分强化，两肺门及纵隔未见肿大淋巴结。球孢子菌感染的CT表现均为不规则病灶，周围可见晕征，两肺门及纵隔淋巴结肿大，3例晕征均出现于球孢子菌感染。结论原发性肺部真菌病CT表现具有一定特征，结合临床表现可在术前做出诊断。

Objective To evaluate the findings of computerized tomography （CT） imaging in patients with primary pulmonary fungal infections. Methods CT findings and clinical data of 18 cases of primary pulmonary fungal infections from 2004 to 2012 were retrospectively analyzed. The diagnoses of all patients were confirmed by pathology or serology. Results The CT of primary pulmonary fungal infections showed soft tissue density nodules in 15 out of 18 cases, and masses in 3 out of 18. By pathology or serological examination, there were 12 cases of Aspergillus infections, 3 cases of cryptococcal infections and 3 cases of coccidioidomycosis. The CT findings of all of the 12 cases of Aspergillus infection showed quasi-circular shaped lesions, with lobulation and spiculation （6/12）, bronchial through syndrome （3/12）, the air crescent sign （6/12）, or mediastinal/hilar lymphadenopathies （3/12）. Six cases presenting air crescent sign were all diagnosed with primary pulmonary aspergillosis. Among 12 aspergillosis cases, 6 cases underwent CT enhancement scan, among which 3 showed no enhancement and 3 showed slight enhancements. The CT findings of all cases of Cryptococcus neoformans infections were cauliflower-like shape, with lobulation, spiculation, and no focal point calcification or mediastinal/hilar lymphadenopathies. After enhancement, all of the lesions were enhanced heterogeneously. The CT findings of all the coccidioidomycosis were irregular shaped lesions with halo sign and mediastinal/hilar lymphadenopathies. All 3 cases of halo signs were diagnosed with primary coccidioidal infections. Conclusions The CT findings of primary pulmonary fungal infections have certain characteristics. Diagnosis could be made based on CT imaging together with clinical manifestations before pathological results are available.