肺实性结节隐球菌病CT影像表现

CT Imaging Manifestations of Pulmonary Solid Nodular Cryptococcosis

目的探讨肺实性结节隐球菌病(PC)的影像学特点,提高肺实性结节隐球菌病诊断准确率。方法回顾性分析20例一共107个肺实性结节(≤3 cm),肺隐球菌病患者的CT影像表现。结果该组20例患者均行穿刺活检,患者口服氟康唑抗隐球菌治疗后随访复查,18例患者3~6个月结节明显缩小,6~12个月基本吸收,2例患者结节2年后才基本吸收并残留少量纤维灶。本研究结果显示:20例患者中病灶位于胸膜下、肺外带分布18例,共105个结节,内带分布2例,共2个结节;病灶单发9例,共9个结节,2个病灶2例,共4个结节,多个病灶(≥3个)9例,共94个结节;病灶有晕征9例,共26个结节,无晕征11例,共81个结节;病灶有空洞1例,共1个结节,无空洞征19例,共106个结节;病灶有胸腔牵拉征4例,共8个结节,无胸膜牵拉征16例,共99个结节;病灶深分叶1例,共1个结节,浅分叶18例,共用103个结节,无分叶1例,共用3个结节;病灶最大短径(≤1 cm)10例,病灶最大短径(>1 cm)10例;纵隔有淋巴结肿大2例,纵隔无淋巴结肿大18例;20例均无钙化。结论肺内实性结节,位于肺胸膜下、肺外带,无或浅分叶,无牵拉征,纵隔无或轻度淋巴结肿大,可伴有晕征,应考虑肺隐球菌病可能。

Objective To investigate the imaging features of pulmonary solid nodule cryptococcosis(PC)and improve the diagnostic accuracy of pulmonary solid nodule cryptococcosis.Methods The CT findings of 20 patients with 107 solid pulmonary nodules(≤3 cm)and pulmonary cryptococcosis were analyzed retrospectively.Results All 20 patients in this group underwent puncture biopsy.Patients were followed up after oral fluconazole anti-cryptococcal treatment.18 patients had nodules significantly reduced in 3 to 6 months,and basically absorbed in 6 to 12 months,and 2 patients had nodules 2 only a few years later did it basically absorb and leave a small amount of fibrous foci.The results of this study show:among the 20 patients,the lesions were located in the subpleural and extrapulmonary zone in 18 cases,a total of 105 nodules,and in the inner zone in 2 cases,a total of 2 nodules;single focus in 9 cases,9 nodules in total,2 lesions in 2 cases,4 nodules in total,multiple lesions(≥3)in 9 cases,94 nodules in total;the lesions had halo sign in 9 cases,a total of 26 nodules,and no halo sign in 11 cases,a total of 81 nodules;there was cavity in 1 case,a total of 1 nodule,and no cavity sign in 19 cases,a total of 106 nodules;there were 4 cases with thoracic traction sign,a total of 8 nodules,and 16 cases without pleural traction sign,a total of 99 nodules;one case had deep lobulation,a total of 1 nodule,18 cases had shallow lobulation,sharing 103 nodules,1 case had no lobulation,sharing 3 nodules;the maximum short diameter(≤1 cm)was 10 cases,and the maximum short diameter(>1 cm)was 10 cases;mediastinal lymphadenopathy in 2 cases and no mediastinal lymphadenopathy in 18 cases;there was no calcification in 20 cases.Conclusion Pulmonary solid nodules are located in the subpleural and extrapulmonary zone of the lung,without or shallow lobulation,no traction sign,mediastinum or mild lymphadenopathy,and may be accompanied by halo sign.The possibility of pulmonary cryptococcosis should be considered.