侵袭性肺曲霉菌病的MSCT表现

目的 探讨侵袭性肺曲霉菌病（IPA）的MSCT表现。方法 回顾性分析41例经临床及病理证实为IPA的MSCT表现。结果 35例血管IPA的MSCT主要表现为多发病灶25例，以肺野外周带分布为主26例；表现为结节或肿块影29例，伴晕征16例，出现空气半月征或空洞20例。6例气道IPA的MSCT主要表现为沿支气管分布的斑片影4例，以双肺中上野分布为主4例。15例血管IPA随访患者中，在出现晕征后的第2、4周分别出现空气半月征6例、空洞4例；5例气道IPA在随访1周时出现斑片结节融合4例，2周时支气管扩张4例，4周时4例支气管扩张加重。结论 血管IPA的MSCT多表现为肺野外周带多发结节或肿块影，常伴晕征或空气半月征或空洞；气道IPA多表现为沿支气管分布的斑片影，以中上肺野分布为主，常合并逐步加重的支气管扩张。IPA进展迅速，CT动态随访观察有助于诊断。

MSCT appearances of invasive pulmonary aspergillosis

Objective To analyze the MSCT appearances of invasive pulmonary aspergillosis (IPA). Methods CT appearances of 41 IPA patients proved by clinical and pathology were retrospectively analyzed. Results The predominant MSCT appearances of 35 cases of blood vessel-IPA were multiple lesions (25 cases), mainly distributed in the peripheral areas of lung field (26 cases), the main features of the lesions were nodules or tumor (29 cases), accompanied with halo sign (16 cases), air crescent sign or cavities (20 cases). The main CT findings of 6 cases of airway-IPA were multiple patches distributed along the bronchi (4 cases), which often existed in the upper and middle of the lung filed (4 cases). Fifteen cases of blood vessel-IPA were followed-up, who performed air crescent sign (6 cases) and cavities (4 cases) after 2 and 4 weeks of halo signs. Five cases of airway-IPA were followed-up, who manifested patches mixed with nodules together in 1 week (4 cases), bronchus expanded in 2 weeks (4 cases), bronchus expanded became severe in 4 weeks (4 cases). Conclusion The MSCT appearances of pulmonary blood vessel-IPA mainly include multiple nodules or tumors in the peripheral areas of lung field, accompanied with halo sign or air crescent or cavities, airway-IPA mainly performe patches which distributes along the bronchi, often existes in the upper and middle of the lung filed and accompanied with a gradually increase of bronchiectasis. IPA has a rapidly progress, and CT dynamic follow-up observing can help to diagnosis.