本文選題：血液學(xué)　切入點(diǎn)：腫瘤　出處：《天津醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:在結(jié)合患者臨床癥狀和體征基礎(chǔ)上,著重分析、歸納不同真菌菌株肺部感染的CT征象,以提高診斷水平。方法:收集2013年2月至2014年12月我院臨床資料完整、基礎(chǔ)病為惡性血液病并繼發(fā)肺部真菌感染病例共128例,其中包括曲霉菌51例、毛霉菌5例、隱球菌8例、白色念珠菌44例、卡氏肺孢子菌20例。初診及治療后均行TOSHIBA16排螺旋CT胸部10mm層厚掃描并1mm層厚薄層重建,獲得并分析CT圖像,分析內(nèi)容包括病灶的類型、形態(tài)、數(shù)目、累及范圍、分布、邊緣、內(nèi)部特征及周圍改變,并對(duì)治療前、后影像學(xué)表現(xiàn)進(jìn)行比較。結(jié)果:不同真菌菌株肺感染CT特征:(1)曲霉菌肺炎:病灶以結(jié)節(jié)樣實(shí)變?yōu)橹?斑片、腫塊、片狀實(shí)變次之,好發(fā)于胸膜下,多為多發(fā)、散在病灶,暈征、壁結(jié)節(jié)、空氣新月征出現(xiàn)率較高,偶可見反暈征;可以伴有胸膜粘連、胸腔積液、縱膈淋巴結(jié)腫大;未見成簇或融合,罕見小葉間隔增厚、肺組織牽拉等。(2)毛霉菌肺炎:胸膜下邊界模糊、邊緣毛糙的結(jié)節(jié)、腫塊、片狀實(shí)變最多見,常多發(fā)、散在,部分可見分葉,可以有壁結(jié)節(jié)及空洞,暈征及反暈征出現(xiàn)率比較高,胸膜粘連多見,常有胸腔積液,可有縱膈腫大淋巴結(jié)。(3)隱球菌肺炎:胸膜下為好發(fā)部位,病灶以結(jié)節(jié)、腫塊樣實(shí)變?yōu)橹?邊緣常不規(guī)則,可呈分葉狀,實(shí)變內(nèi)空洞多見,部分病灶有融合趨勢(shì),未見壁結(jié)節(jié)及空氣新月征,也可表現(xiàn)為樹芽及粟粒樣血行播散樣改變。(4)白色念珠菌肺炎:均為多發(fā)病灶,形態(tài)多樣,可以表現(xiàn)為斑片、結(jié)節(jié)、索條、片狀實(shí)變、磨玻璃密度、樹芽及粟粒等,并常常共存,可以見到暈征,實(shí)變內(nèi)可見不規(guī)則空洞,未見壁結(jié)節(jié)及空氣新月征出現(xiàn),可伴發(fā)多臟器感染。(5)卡氏肺孢子菌肺炎:病灶以彌漫性磨玻璃密度為主,病變區(qū)內(nèi)可見小葉中心性或腺泡結(jié)節(jié)樣影、斑片狀實(shí)變、網(wǎng)狀影和索條影,部分病例可見融合的片狀實(shí)變,亦可見到氣囊,均為兩肺葉同時(shí)受累,部分病例胸膜下較少累及,胸腔積液、胸膜粘連、縱膈重大淋巴結(jié)少見,未見壁結(jié)節(jié)、空洞、反暈征。結(jié)論:本組病例不同菌株肺部真菌感染的CT表現(xiàn)各具特征性,CT在常見真菌肺感染中有重要的實(shí)用價(jià)值。
[Abstract]:Objective: based on the clinical symptoms and signs of the patients, the CT signs of pulmonary infection of different fungal strains were summarized in order to improve the diagnostic level. Methods: from February 2013 to December 2014, the clinical data of our hospital were collected. There were 128 cases of malignant hematopathy and secondary pulmonary fungal infection, including 51 cases of Aspergillus, 5 cases of Mucor, 8 cases of Cryptococcus, 44 cases of Candida albicans. Twenty cases of Pneumocystis carinii were examined and treated with TOSHIBA16 slice spiral CT (10 mm slice thickness of chest and 1 mm slice thickness reconstruction). The CT images were obtained and analyzed, including the type, shape, number, range, distribution and edge of the lesions. Results: Ct features of pulmonary infection of different fungal strains were compared with CT features of aspergillus pneumoniae. It usually occurs under the pleura, and is mostly multiple, with a high occurrence rate of lesion, halo sign, wall nodule and air crescent sign. It may be accompanied by pleural adhesion, pleural effusion, mediastinal lymphadenopathy, no clustering or fusion. Rare lobular septal thickening, lung tissue pulling, etc.) Mycobacterium pneumoniae: subpleural border is blurred, edge rough nodules, masses, flaky consolidation is most common, often multiple, scattered, some lobes can be seen, can have wall nodule and cavity, The occurrence rate of halo sign and anti-halo sign is high, pleural adhesion is more common, pleural effusion is often seen, and mediastinal enlargement lymph node. 3) Cryptococcus pneumonia: subpleural is the predilection place, the focus is nodule, mass like consolidation, the margin is often irregular, It can be lobulated, with more solid cavity, some lesions have fusion trend, no wall nodule and air crescent sign, also can be shown as tree bud and miliary blood dispersal change. 4) Candida albicans pneumonia: all the lesions are multiple lesions, and the morphology is various. They can be seen as plaques, nodules, cord strips, flake consolidation, ground glass density, tree buds and millet grains, and often coexist. Halo signs can be seen, irregular cavities can be seen in solid changes, and no wall nodule or air crescent sign can be seen. Pneumocystis carinii pneumonia may be accompanied by multiple organ infection. The focus is mainly diffuse glass-grinding. Central lobular or acinar nodular shadow, patchy consolidation, reticular shadow and stripe shadow can be seen in the lesion area. In some cases, there were flake consolidation of fusion, and airbags, both of which were involved in both lobes at the same time. Some cases had less involvement under the pleura, pleural effusion, pleural adhesions, mediastinal major lymph nodes, no wall nodule, cavity, etc. Conclusion: the CT findings of different strains of pulmonary fungal infection have important practical value in common fungal pulmonary infection.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R733;R519;R730.44

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