Pulmonary cryptococcosis: comparison of CT findings in immunocompetent and immunocompromised patients
Pulmonary cryptococcosis: comparison of CT findings in immunocompetent and immunocompromised patients
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DOI：
10.1177/0284185114529105
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发表时间：
2015-04-01
期刊：
影响因子：
1.3
通讯作者：
Shi, Yu-xin
中科院分区：
文献类型：
--
作者：
Xie, Li-xuan;Chen, You-san;Shi, Yu-xin
背景资料：肺隐球菌病患者的CT表现已有报道，但许多报道局限于患者数量少，且未考虑免疫功能正常和免疫功能低下患者的区别。目的：回顾性分析免疫状态从正常到严重受损的肺隐球菌病患者的胸部CT表现，材料与方法：回顾性分析29例免疫功能正常和43例免疫功能低下的肺隐球菌病患者的CT表现。结果：肺结节/肿块（单发或多发）是最常见的CT表现，占65 72例患者中，90.3%的患者有肺动脉高压，相关表现包括CT晕轮征（n = 24）、空洞（n = 23）和支气管充气征（n = 17）。实变区（n = 14）、GGO区（n = 13）、线性阴影（n = 11）、淋巴结病（n = 5）和胸腔积液（n = 8）不常见。47例（65.2%）病例的实质异常位于外周。免疫功能低下的患者比免疫功能正常的患者（P = 0.009），艾滋病患者比非艾滋病免疫功能低下的患者（P = 0.002）更频繁地出现结节/肿块内的空洞。免疫功能正常的患者比免疫功能低下的患者更常出现结节/肿块内的支气管充气征（P = 0.005）。结论：在肺内单发或多发结节性病变的鉴别诊断中，应考虑肺隐球菌病的可能性。免疫功能低下患者，尤其是AIDS患者中，结节/肿块内的空洞更常见，而免疫功能正常的患者中，支气管充气征更常见。
Background: Computed tomography (CT) findings in patients with pulmonary cryptococcosis have been reported, however, many reports were limited by the small number of patients, and not taken into account the distinction between immunocompetent and immunocompromised patients.Purpose: To retrospectively evaluate thoracic CT findings in patients with pulmonary cryptococcosis whose immune status ranged from normal to severely compromised, and determine characteristic imaging features of pulmonary cryptococcosis between patients with different immune status.Material and Methods: CT scan findings of 29 immunocompetent and 43 immunocompromised patients with clinically proven pulmonary cryptococcosis were reviewed retrospectively. Different patterns of CT scan abnormalities between immunocompromised and immunocompetent patients, AIDS and non-AIDS immunocompromised patients were compared by Fisher's exact test.Results: Pulmonary nodules/masses, either solitary or multiple, were the most common CT finding, present in 65 (90.3%) of the 72 patients; associated findings included CT halo sign (n = 24), cavitation (n = 23), and air bronchogram (n = 17). Areas of consolidation (n = 14), areas of GGO (n = 13), linear opacities (n = 11), lymphadenopathy (n = 5), and pleural effusion (n = 8) were uncommon. The parenchymal abnormalities were peripherally located in 47 (65.2%) of the cases. Cavitations within nodules/masses were more frequently present in immunocompromised patients than in immunocompetent patients (P = 0.009), and in AIDS patients than in non-AIDS immunocompromised patients (P = 0.002). Air bronchograms within nodules/masses were more frequent present in immunocompetent patients than in immunocompromised patients (P = 0.005). Nodules/masses with halo sign were less frequent in AIDS patients than those in non-AIDS immunocompromised patients (P = 0.027).Conclusion: Pulmonary cryptococcosis should be considered in the differential diagnosis of solitary or multiple pulmonary nodules. Cavitations within nodules/masses were more commonly seen in immunocompromised patients, especially AIDS patients, while air bronchograms were more commonly seen in immunocompetent patients.