器官移植后肺曲霉菌感染CT表现及与细菌感染的鉴别诊断

Computed tomographic manifestations of pulmonary aspergillosis after organtransplantation anddifferential diagnosis with bacterial infectionGe Xihong], Li Hang2 , Sun Yan3 , Wang Mingyue4 , Gao Guangfeng^, Long Miaomiao^, LiuObjective

目的比较和分析器官移植术后肺曲霉病与细菌感染CT表现的差异。方法收集器官移植术后诊断肺曲霉菌感染的62例受者,与同期匹配的肺细菌感染的68例受者比较,CT将病变描述为实变、肿块、大结节(≥1cm)、小结节、树芽征等形式,对每一种征象,按照有鉴别诊断价值的细节如数量、晕征、空气支气管征、反晕征及病变内低密度征、空洞等进行进一步区分,比较两者之间的差别。结果器官移植术后肺曲霉菌感染多为两种及以上形式。其中最常见表现为大结节,约占75. 8%,其次为实变(48. 4%)及肿块(29. 0%),小结节(16. 1%)和树芽征(12. 9%)多为伴随表现。曲霉菌感染表现为肿块的比例高于细菌(分别为29.0%和& 8%,PV0. 05),细菌感染实变表现高于曲霉菌(分别为69. 1%和48.4%,P<0.05)。大结节中,细菌及曲霉菌感染各种征象比例差异无统计学意义。实变表现中,空气支气管征细菌感染比例高于曲霉菌感染(分别为7& 8%和40. 0%,P<0. 05),曲霉菌形成空洞的比例高于细菌(分别为63. 3%和27. 7%,P<0. 05)。肿块表现中,曲霉菌感染病变多为单发(单发66.7%),内容易看到空洞(83.3%)、空气新月征(77.8%)。出现晕征的比例为30.7%。结论器官移植后曲霉菌感染表现多样,可表现为大结节、实变、肿块、小结节及树芽征。与细菌感染表现既有一定的区别,又有一定的重叠。

Objective To summarize the computed tomographic(CT)manifestations of pulmonary aspergillosis after organ transplantation and compare different signs between pulmonary aspergillosis and bacterial pneumonia.Methods CT images of pulmonary aspergillosis(n=62)and bacterial pneumonia(n=68)in post-transplantation patients were reviewed.The signs were categorized with consolidation,mass,large nodule(24cm),small nodule and bud-in-tree pattern.Some detailed useful differentiating signs such as halo sign,air bronchogram sign,reversed halo sign,hypodensity sign and cavitation were also analyzed.Results CT patterns o pulmonary aspergillosis included consolidation,mass,large nodule,small nodule and bud-in-tree pattern.The most common was large nodule(75.8%),followed by consolidation(48.4%)and mass(29.0%).And small nodule(16.1%)and bud-in-tree(12.9%)patterns were concurrent.For consolidation pattern,the proportion of bacterial pneumonia(69.[%)was the larger;For mass pattern,the proportion of pulmonary aspergillosis(29.0%)was the larger.For large nodule pattern,there was no difference.The detail sign of large nodule in two groups had no difference.In detailed signs of consolidation pattern,air bronchogram sign was more often seen in bacterial pneumonia while cavitation was more frequently found in pulmonary aspergillosis.]n detailed signs of mass pattern,pulmonary aspergillosis often has single lesion(66.7%),cavitation(83.3%)and air crescent sign(77.8%)is more common.The proportion of halo sign was 30.7%.Conclusions CT manifestations of pulmonary aspergillosis are diverse after organ transplantation.There is some difference and yet overlap with bacterial pneumonia.