病例讨论——肺炎支原体肺炎汇总.ppt

31-year-old man with severe M. pneumoniae pneumonia with respiratory failure requiring mechanical ventilation. CT shows bilateral air-space consolidation and pleural effusion. BMC Medical Imaging 2009, 9:7 doi:10.1186/1471-2342-9-7 (4) 31-year-old man with severe M. pneumoniae pneumonia with respiratory failure requiring mechanical ventilation. CT shows bilateral air-space consolidation and pleural effusion. BMC Medical Imaging 2009, 9:7 doi:10.1186/1471-2342-9-7 (4) 浸润性肺结核（infiltrative pulmonary tuberculosis） 共同点：都可出现小叶中心性分布的病灶，结节状或小斑片状气腔实变影及树芽征, 都很少出现间质纤维化改变 不同点：浸润性肺结核多见于年长儿，结核中毒症状较重。多位于肺上叶，呈多样性，肺内播散灶为边界清晰的多发点状、小结节状阴影，变化缓慢，吸收后仍留有痕迹，即影像学可见新旧病灶并存，出现钙化，少见GGO MPP短期内病变范围迅速扩大，且一般在治疗1～2周可以明显吸收或完全吸收。 鉴别主要还是通过痰涂片和实验室检查。 Axial CT image shows consolidation and ill-defined nodules in the posterior segment of right upper lobe in a neutropenic patient with tuberculous infection. Diagn Interv Radiol 2008;14:75-82 巨细胞病毒性肺炎（cytomegalovirus pneumonia, CMP） 病原体CMV属疱疹病毒β亚科，为双链DNA病毒，可通过体液传播 CMP是免疫抑制患者最常见的致命性并发症之一，常见于免疫缺陷患者，例如器官移植患者、AIDS患者及服用过免疫抑制药物的患者，也可发生于各种年龄的血液病患者 CMP的主要病理表现为弥漫性肺泡损伤及局灶性间质性肺炎。CMP的影像学表现主要以病理学改变为基础 GGO是CMP最常见的影像学表现 CMV的典型影像表现 ：双侧弥漫性分布的微小结节，直径1-5mm，边缘光滑或不规则，磨玻璃密度，为间质性肺炎的表现 常见胸腔积液及淋巴结肿大 Axial CT image shows bilateral centrilobular nodules and pleural effusion in Cytomegalovirus infection in a 38-year-old bone marrow recipient. Diagn Interv Radiol 2008;14:75-82 A 31-year-old woman with cytomegalovirus pneumonia after bone marrow transplantation. HRCT scan (1.5-mm collimation) demonstrates numerous small nodules (arrows) Eur Radiol (2003) 13:515–521 DOI 10.1007/s00330-002-1490-3 (5) 24-year-old man with M. pneumoniae pneumonia. CT shows centrilobular nodules (tree-in-bud appearance,arrows). Bronchial wall thickening is also seen. BMC Medical Imaging 2009, 9:7 doi:10.1186/1471-2342-9-7 (4) Pneumonia due to cytomegalovirus in a 45-year-old man who underwent liver transplantation.(a) Chest radiograph obtained 4 weeks after liver transplantation shows patc