免疫缺陷患者感染巨细胞病毒性肺炎的CT影像特点分析

CT imaging features of patients with immune deficiency complicated by cytomegalovirus pneumonia

目的分析免疫缺陷患者感染巨细胞病毒性(cytomegalovirus,CMV)肺炎的肺部影像特点。方法回顾性分析7例经临床确诊的MNC性肺炎的临床及影像资料。7例患者均行胸部CT检查,其中异基因造血干细胞移植术后5例,肾病综合征1例,IgA肾病1例。由2位中级以上影像科医生共同进行图像分析。结果异基因造血干细胞移植术后感染CMV性肺炎的患者5例中,全部病例双肺对称弥漫或散在分布的磨玻璃影,病灶内均可见散在小结节灶,伴有双侧胸膜增厚及纵隔淋巴结肿大。IgA肾病患者1例双肺散在对称分布间质增生,病灶内均可见散在小结节灶,伴有双侧胸膜增厚及纵隔淋巴结肿大,同时伴有支气管血管束增粗、小叶间隔及小叶内间隔增厚,牵拉性支扩征象。结论免疫缺陷患者感染巨细胞病毒性肺炎的胸部CT表现为弥漫或散在对称分布的磨玻璃影,伴病灶内多发性小结节灶,累及胸膜及纵隔淋巴结肿大,伴或不伴实变灶时,应提示肺内病变为CMV性肺炎的可能。

Objective To investigate the pulmonary imaging characteristics of patients with immune deficiency complicated by cytomegalovirus(CMV) pneumonia.Methods The clinical and imaging data of 7 patients with CMV pneumonia were retrospectively analyzed,including 4 females and 3 males,aged from 15 to 44 years,with the median age being22 years.The 7 patients underwent chest CT examination,in whom,there were 5 cases of allogeneic hematopoietic stem cell transplantation,1 cases of nephrotic syndrome,1 cases of Ig A nephropathy.The image analysis was performed by 2 middle and senior doctors.Results In the 5 patients with CMV pneumonia due to allogeneic hematopoietic stem cell transplantation,the ground glass shadow could be observed in the distribution of symmetric diffuse or scattered in both lungs,and the scattered small nodules were seen in the lesions,with bilateral pleural thickening and mediastinal lymph nodes.In 1 patients with Ig A nephropathy,the symmetrical distribution mesenchymal hyperplasia was found,with scattered small nodular in the lesions,accompanied by bilateral pleural thickening and mediastinal lymph node enlargement in both lungs,and accompanied by the bronchovascular bundle thickening,interlobular and intralobular septal thickening,pull bronchiectasis sign.Conclusion The chest CT manifestations of patients with immune deficiency complicated by cytomegalovirus pneumonia are diffused,scattered or symmetrical distribution of ground glass shadows,with multiple small nodules in the lesions,the lesions are involved in the pleural and mediastinal lymph nodes,with(or without) consolidation lesions,which suggests that the lung lesions may become CMV pneumonia.