原发性肺隐球菌病的CT影像和病理表现

李晓光; 谢宗玉; 康厚艺; 毛怡; 马强; 张伟国

doi:10.13898/j.cnki.issn.1000-2200.2019.11.022

原发性肺隐球菌病的CT影像和病理表现

Analysis of CT images and pathological features of primary pulmonary cryptococcosis

摘要

摘要:
目的探讨原发性肺隐球菌病的CT影像表现和病理表现，提高该病术前诊断水平。
方法回顾性分析经病理证实的31例原发性肺隐球菌病的CT影像及病理结果。
结果31例中单发结节/团块型16例，多发结节/团块型6例，浸润实变型5例，混合型4例。21例（67.7%）位于肺外周胸膜下区，11例（35.3%）见“胸膜凹陷征”，10例（32.3%）见“空气支气管征”，9例（29.0%）见“毛刺征”，8例（25.8%）见“晕征”。25例行增强扫描，6例见“血管造影征”；其中21例呈轻中度强化（19例均匀，2例不均匀），4例呈重度均匀强化。病理上所有病灶表现为肉芽肿样病变，其内可见大量隐球菌孢子。
结论原发性肺隐球菌病CT表现多样，以肺外周胸膜下结节/团块多见，可伴“毛刺征”“空气支气管征”“晕征”及“胸膜凹陷征”和轻-中度均匀强化，有助于对其做出早期诊断。

Abstract:
ObjectiveTo observe the CT images and clinical pathological features of primary pulmonary cryptococcosis(PPC), so as to improve its diagnostic accuracy.
MethodsThe data of CT image and pathological features of 31 cases with PPC confirmed by histopathology were retrospectively analyzed.
ResultsAmong 31 patientts, solitary nodule/mass in 16 cases, multiple nodules/mass in 6 cases, infiltrative consolidation in 5 cases and mixed type in 4 cases were identified.Among 31 cases, 21 cases located in subpleural region(67.7%), 11 cases showed pleural "indentation sign"(35.3%), 10 cases showed "air bronchogram" (32.3%), 9 cases showed "speculation"(29.0%) and 8 cases showed "halo sign"(25.8%), respectively.The enhanced CT scan in 25 cases were implemented, 6 cases with "angiographic sign", 21 cases with mild or moderate enhancement(including 19 cases with niform and 2 cases with uniform) and 4 cases with obvious homogeneous enhancement were found.Histopathologically, all lesions were granulomatous with abundant cryptococcal spores.
ConclusionsThe CT features of PPC are various, the nodules/masses in the subpleural area of lower lung are most common, which is complicated with "speculation", "air bronehogram", "halo sign", pleural indentation sign", mild or moderate homogeneous enhancement.These findings may be helpful for the preoperative diagnosis.

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