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目的回顾性分析隐匿性原发性肺隐球菌病的临床及影像表现,提高对该病的认识水平。方法结合国内外文献,回顾性分析5例经手术病理或穿刺活检证实的隐匿性原发性肺隐球菌病的临床、X线及CT表现。结果男4例,女1例;年龄37~57岁,平均45岁。均为体检发现,过去史、临床症状、体格检查、实验室检查均无阳性发现。CT常表现为多发结节或肿块,可伴实变及少量斑片影。CT分型:结节肿块型2例,混合型(结节肿块伴实变、斑片)3例。病变位置:右肺3例,两肺2例;右肺上叶1例,右肺下叶1例,2个肺叶及以上3例。大部分病灶位于胸膜下,与胸膜关系密切。结节和肿块大小不等,无分叶,可见毛刺,周围可伴磨玻璃影,空洞少见,无钙化,周围支气管无受累或牵拉,不合并胸腔积液及纵隔淋巴结肿大。术前诊断:肺隐球菌1例,结核1例,纵隔占位1例,肺炎2例。确诊方式:手术病理2例,穿刺活检3例。处理方式:手术切除2例(结节肿块型),保守抗菌治疗3例(混合型)。临床转归及影像随访:均治愈或吸收好转。结论隐匿性原发性肺隐球菌病中年男性好发,诊断困难,影像学检查在诊断和治疗随访中具有重要意义。
Objective To retrospectively analyze the clinical and imaging manifestations of occult primary pulmonary cryptococcosis and to raise the level of understanding of the disease. Methods The clinical, radiographic and CT manifestations of 5 patients with occult primary pulmonary cryptococcosis confirmed by pathology or biopsy were retrospectively analyzed. Results 4 males and 1 female; aged 37 to 57 years, mean 45 years. Are physical examination found that the past history, clinical symptoms, physical examination, laboratory tests were found no positive. CT often showed multiple nodules or lumps, with solid and a small amount of patchy shadow. CT typing: 2 cases of nodular mass, mixed type (nodular mass with consolidation, patch) in 3 cases. Lesions: 3 cases of right lung, 2 cases of two lungs; 1 case of upper right lung, 1 case of right lower lobe, 2 lobes and 3 cases of above. Most lesions in the subpleural, and pleural closely. Nodules and lumps of varying sizes, no lobulation, visible burr, around with ground glass, rare cavity, no calcification, bronchial involvement or traction around, without pleural effusion and mediastinal lymph nodes. Preoperative diagnosis: pulmonary cryptococcosis in 1 case, tuberculosis in 1 case, mediastinal mass in 1 case, pneumonia in 2 cases. Diagnostic methods: surgical pathology in 2 cases, biopsy in 3 cases. Treatment: surgical resection in 2 cases (nodular tumor type), conservative antibacterial therapy in 3 cases (mixed type). Clinical outcome and follow-up: All were cured or absorbed better. Conclusions Occult primary pulmonary cryptococcosis is a middle-aged male with poor diagnosis and imaging examination is of great significance in the diagnosis and treatment follow-up.