在计算机断层扫描上出现多个结节的肺囊性肺炎
Saori Ikeda1, Noriyo Yanagawa2
1Department of Internal Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
肺囊性肺炎 (PCP) 可以在CT扫描上呈现为多个结节,即使在非HIV患者中也是如此. 这一案例凸显了PCP作为血造干细胞移植后患者多重肺结节的关键差异诊断.
科学领域:
- 医疗成像医学成像
- 传染性疾病 传染性疾病
- 血液学 血液学 血液学
背景情况:
- 肺囊性肺炎 (PCP) 是一种重要的机会性感染.
- 计算机断层扫描 (CT) 上的多个结节是PCP的非典型发现,特别是在非人类免疫缺陷病毒 (HIV) 病例中.
- 接受血造干细胞移植 (HSCT) 的患者有增加的机会性感染风险,如PCP.
研究的目的:
- 报告一个独特的PCP病例,在HSCT后的患者中呈现多个肺结节.
- 强调在免疫受损患者多重肺结节的差异诊断中考虑PCP的重要性.
- 为了说明在适当治疗后异常PCP发现的放射性分辨率.
主要方法:
- 一个47岁的女性在HSCT后患有急性髓性白血病的病例报告.
- 诊断工作包括计算机断层扫描 (CT),血清学标记 (升高的β-d葡萄糖) 和分子检测 (支气管洗液上的PCP PCR).
- 临床诊断PCP是基于症状,成像和实验室发现,尽管不典型的结节呈现.
主要成果:
- CT显示了多个结节和细分整合与下节省.
- 患者的病情是不耐治疗的levofloxacin.
- 通过对支气管洗液的阳性PCR证实了PCP.
- 用trimethoprim/sulfamethoxazole治疗导致结核和巩固在随访CT时的解决.
结论:
- 在CT检测到多个肺结节的差异诊断中,应考虑肺囊性肺炎 (PCP) 在接受血造干细胞移植 (HSCT) 的患者中.
- PCP的非典型表现,如多个结节,可以发生并通过适当的抗菌药物治疗而消失.
- 这一案例强调了在免疫受损患者呈现异常放射性发现时,对PCP的高怀疑指数的需要.
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