4例肺奴卡菌病的影像学表现及文献复习

Pulmonary Nocardiosis in 4 Cases of Lung Imaging Findings and Literature Review

目的探讨肺奴卡菌病的影像学表现,以提高对该病的认识。方法搜集4例经细菌学证实的肺奴卡菌病病例的临床资料,分析其影像学表现并复习相关国内外文献。结果 4例均为免疫抑制患者。胸部主要影像学征象：肺部病灶内合并空洞者3例,其中以斑片影并空洞1例,结节并空洞2例,病灶单发或多发,可相互融合呈大片状;肺部斑片状渗出灶1例;单侧或双侧胸腔少量积液3例。其他并发征象：4例均见脑内多发脓肿;1例并发腹膜炎、右竖脊肌与左臀肌脓肿。结论肺奴卡菌病影像学表现多样,若表现为空洞的实变或结节,同时并发脑内或其他部位脓肿,结合患者免疫功能低下,首先考虑肺奴卡菌病,最终确诊依靠细菌学检查。

Objective To investigate imaging findings of pulmonary nocardiosis,in order to improve the understanding of the disease. Methods The clinical data of 4 cases of pulmonary nocardiosis confirmed by bacteriology were collected and the imaging findings were analyzed and the relevant literatures were reviewed. Results All these cases were immunosuppressed patients. Major chest imaging findings were： Lesion with internal cavities in 3 cases,included patch shadow（ 1 cases） and different size nodules（ 2 cases）. Lesions were solitary or multiple and could merge each other into big shape shadow. Unilateral or bilateral pleural effusion in 3 cases. Other signs were： Multiple abscess of brain in all the 4 cases;peritonitis,the right erector muscle abscess and the left gluteal muscle abscess in 1 case. Conclusion The imaging manifestations of pulmonary nocardiosis are diverse,such as cavitary consolidation or nodules,and concurrent abscesses in the brain or other areas. In combination with patients with low immune function,the first consideration is pulmonary nocardiosis,and the final diagnosis depends on bacteriology.