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目的探讨免疫功能无异常的原发性肺隐球菌病患者 CT 征象及 CT 引导下经皮肺穿刺活检在诊断中的价值。方法回顾性分析浙江大学医学院附属邵逸夫医院经病理证实的12例原发性肺隐球菌病患者的临床资料。结果 (1)12例患者的 CT 征象均为单肺叶发病,其中单发结节4例,局限性多发混杂的结节和(或)肿块和(或)肺实变8例,此外还可见支气管充气征/小泡征(9例)、空洞(2例)和“晕”征(4例)。(2)9例行 CT 引导下经皮肺穿刺活检,其中7例病理学确诊。(3)12例患者中7例行手术切除,术后2例行氟康唑治疗,余5例未用药,其中1例术后5个月发生隐球菌性脑膜炎;另5例用氟康唑治疗。结论免疫功能无异常者时有发生肺隐球菌病的可能;肺隐球菌病的临床症状与影像学表现明显不相称;大多数肺隐球菌病的 CT 主要征象为局限性多发混杂的结节和(或)肿块和(或)肺实变,如同时有支气管充气征/小泡征、晕征,则具有特征性;尽早采用CT 引导下经皮穿刺活检将有助于该病的早期诊断;氟康唑治疗该病效果好,有助于预防严重并发症的发生。
Objective To investigate the CT features of patients with primary pulmonary cryptococcosis without abnormal immune function and the value of CT-guided percutaneous lung biopsy in the diagnosis. Methods The clinical data of 12 patients with primary pulmonary cryptococcosis confirmed by pathology were retrospectively analyzed in the Run Run Shaw Hospital of Zhejiang University School of Medicine. Results (1) The CT findings of all the 12 patients were single lobe. Among them, 4 had solitary nodules, 8 had mixed localized nodules and / or lumps, and / or 8 had pulmonary consolidation. In addition, bronchial Inflatable sign / vesicle sign (9 cases), empty (2 cases) and “halo” signs (4 cases). (2) Nine cases underwent CT guided percutaneous lung biopsy, of which 7 cases were pathologically confirmed. (3) Of the 12 patients, 7 patients underwent surgical resection. Two patients were treated with fluconazole after operation, and the remaining 5 patients were not treated. One patient developed cryptococcal meningitis 5 months after operation. The other 5 patients received fluconazole, Azole therapy. Conclusions There is a possibility of developing pulmonary cryptococcosis when there is no abnormal immune function. The clinical symptoms and imaging manifestations of pulmonary cryptococcosis are obviously not commensurable. Most CT signs of pulmonary cryptococcosis are confined mixed nodules and (Or) lumps and / or lung consolidation, such as bronchial inflatable / vesicular signs, halo sign, is characteristic; as early as possible by CT-guided percutaneous biopsy will help early diagnosis of the disease; Fluconazole treatment of the disease effect is good, help prevent the occurrence of serious complications.