AIDS合并马尔尼菲青霉菌感染的胸部CT表现

Chest CT findings of HIV-related penicillium marneffei infection

目的:探讨获得性免疫缺陷综合征(AIDS)合并马尔尼菲青霉菌(PM)感染的胸部CT表现。方法:回顾性分析52例AIDS合并马尔尼菲青霉菌病(PSM)患者的临床及胸部CT表现。结果:52例AIDS合并PSM患者中,胸部CT表现为磨玻璃密度影或斑片影19例(占36.5%)、实变影7例(占13.5%)、粟粒结节(≤5mm)25例(占48.1%)、结节(>5mm,≤3cm)16例(占30.8%)、肿块(>3cm)1例(占1.92%)、空洞7例(占13.5%)、支气管扩张7例(占13.5%)、肺间质病变31例(占59.6%)、心包积液5例(占9.6%)、胸腔积液11例(占21.2%)、胸膜增厚23例(占44.2%)、纵隔淋巴结肿大32例(占61.5%)。病变累及双侧肺38例(占73.1%)、累及肺段数≥2者42例(占80.8%)。6例肺部无病变,但临床表现均异常。结论:AIDS合并PSM患者的胸部CT常见征象为磨玻璃密度影或斑片影、粟粒结节或结节、间质病变、胸腔积液及纵隔淋巴结肿大,其中磨玻璃密度影、散在多发随机分布的粟粒结节或结节、肺间质病变、病变多为双肺、多叶段分布较具特点,结合发热、特异性"脐凹"样皮疹、CD4^+ T淋巴细胞计数<20个/μL等特征,可高度提示该病诊断。

Objective:To investigate the chest CT characteristics of HIV-related penicillium marneffei infection.Methods:The chest CT imaging of 52 HIV patients with penicillium marneffei infection was retrospectively analyzed.Results:Ground glass opacity or patchy shadows was observed in 52(19,36.5%)patients,followed by consolidation(7,13.5%),miliary nodules(25,48.1%),nodular pattern(16,30.8%),mass(1,1.92%),cavitation(7,13.5%),bronchiectasia(7,13.5%),pulmonary interstitial lesion(31,59.6%),pericardial effusion(5,9.6%),pleural effusion(11,21.2%),pleural thickening(23,44.2%),and enlarged mediastinum lymph nodes(32,61.5%).Thirty eight(73.1%)patients showed bilateral lung involvement,42(80.8%)patients involved at least 2 lung segments,and 6 patients showed normal lung imaging.Conclusion:The common signs of CT imaging in patients with HIV-related penicillium parneffei infection are miliary nodules,interstitial involvement,bilateral lung involvement and involvement of multiple segments.If patient has specific clinical manifestations including high fever,umbilical-like rash and CD4+T lymphocyte counts less than 20 cells/μL,it will be helpful to improve the diagnostic accuracy.