造血干细胞移植后侵袭性真菌肺部感染CT表现

CT Performance of Pulmonary Invasive Fungal Infection after Hematopoietic Stem Cell Transplantation

目的分析造血干细胞移植后侵袭性真菌肺部感染的CT表现及病程中的影像学变化及预后。方法回顾性分析27例白血病、淋巴瘤等恶性血液病患者进行造血干细胞移植后出现侵袭性真菌肺部感染后3个月至2年中出现胸部异常的多次CT影像表现。结果27例患者中首诊胸部CT单发结节或肿块8例，双肺多发结节、肿块4例，肺内片状实变影6例，伴肺不张2例，单发结节状磨玻璃影2例，主要伴随征象包括晕征、树芽征、空洞、支气管气像及空气新月征等，15例患者抗真菌治疗后病灶有不同程度吸收，6例患者13个结节或肿块内出现空洞。6例患者治疗后病情加重，其中4例死于严重肺部感染及原发病。结论造血干细胞移植后侵袭性真菌性肺部感染CT表现以结节、肿块并伴有伴随征象常见。治疗后复查CT结节或肿块吸收较慢且病灶易出现空洞。

Objective To analyze dynamic pulmonary CT performance and prognosis of patients with invasive fungal disease （IFD） after hematopoietic stem cell transplantation （HSCT）. Methods A retrospective investigation of the CT features and the e- volution process was carried out in 27 clinical diagnosed patients with pulmonary IFD after t-ISCT of underlying disease of leukemia or lymphoma. Results The first abnormal CT finding showed single nodule or mass in 8 cases,multiple nodules or masses in 4 ca- ses,lung consolidation in 2 case,single ground glass opacity（GGO） in 2 case. 15 cases of patients reached improved performance af- ter drug treatment. 13 nodules or masses turned cavitation in 6cases. 2 cases reached worse 4 cases died because of serious infection and protopathy. Conclusion Nodule or mass is the most common CT finding of pulmonary IFD after HSCT treatment. The absorp- tion of nodules and masses was slow and could turn cavitation.