论文部分内容阅读
目的提高对肾移植受者并发卡氏肺囊虫肺炎(PCP)影像学特点的认识。方法总结24例肾移植受者并发PCP的影像学表现,分析其治疗前后的动态变化。结果男19例,女5例;平均年龄392岁。发病距肾移植时间平均56个月,起病至就诊时间平均55d,发热24例,呼吸困难24例。病理表现为肺泡内蛋白样物质渗出,肺泡上皮细胞变性,肺泡间隔增宽,局部可见纤维化样改变。就诊时胸部X线10例呈弥漫性改变,其中3例磨玻璃样改变,2例磨玻璃样改变中见网格样改变,4例伴有片状渗出或融合实变。就诊时24例胸部CT均可见磨玻璃样改变,其中9例可见细网格状改变,12例可见边缘模糊的片状渗出影及肺内实变影。随着病情加重,胸部X片、CT出现肺内渗出和实变增多,明显时可见支气管空气影。约1~2周内发展到高峰。治疗有效后约1周,胸部X片及CT出现病变吸收好转的改变,1个月内基本吸收。结论肾移植患者卡氏肺囊虫肺炎影像学表现为两肺弥漫性改变包括间质改变或肺泡渗出、实变,进展快,治疗有效后约1周胸部X片及CT才出现吸收好转的改变,1个月内基本吸收。胸部CT检查比X片更敏感。
OBJECTIVE To improve the understanding of the imaging features of patients with renal transplant recipients with Pneumocystis carinii pneumonia (PCP). Methods The imaging findings of 24 cases of renal transplant recipients complicated with PCP were summarized, and their dynamic changes before and after treatment were analyzed. Results There were 19 males and 5 females with an average age of 392 years. The incidence of kidney transplantation from an average of 56 months, onset to treatment time average 55d, 24 cases of fever, 24 cases of dyspnea. Pathological manifestations of alveolar protein-like material exudation, alveolar epithelial cell degeneration, alveolar septum widening, local changes seen in fibrosis. Chest X-ray showed diffuse changes in 10 cases, 3 cases of ground-glass changes, 2 cases of ground-glass changes in the grid-like changes, 4 cases with exudate or fusion consolidation. Visible 24 cases of chest CT were ground-glass-like changes, of which 9 cases showed fine mesh changes, 12 cases can see the edges of fuzzy effusion shadow and intraparenchymal shadow. With the exacerbations, chest X-ray, CT pulmonary effusion and consolidation increased, obviously visible bronchial air shadow. About 1 to 2 weeks to the peak. About 1 week after the treatment is effective, changes in the absorption of the lesion in the chest X-ray and CT are basically absorbed within 1 month. Conclusions Renal transplantation patients with Pneumocystis carinii pneumonia imaging manifestations of diffuse changes in both lungs, including interstitial or alveolar exudate, consolidation, rapid progress, about 1 week after treatment, the chest X-ray and CT showed improved absorption Change, basic absorption within 1 month. Chest CT examination is more sensitive than X-ray.