AIDS相关胸部疾病的影像诊断2.ppt

淋巴结结核 AIDS合并肺TB（混合感染） 血中找到猪霍乱杆菌 AIDS合并肺TB AIDS合并肺TB AIDS合并肺TB 继发性肺结核 非典型分枝杆菌（Atypical mycobacteria） 临床特点：CD4+低（50×106/L)，胃肠道获感染, CD4+ counts below 50×106/L cells, acquired via the gastrointestinal tract 1/3AIDS发病,血培养或骨髓抽吸明确诊断 MAC affects up to 35% of patients during the course of their illness 影像:间质性或腺泡渗出，肺门淋巴结肿大和少见的空洞 Imaging finding : interstitial or alveolarinfiltrates,Hilar lymphadenopathy, rarely cavitation 与结核类似，胸腔积液或正常的胸片更为常见 Similar to Mycobacterium tuberculosis, pleural effusions or a normal chest radiograph are more common 粟粒状、结节状病灶少见,可有“树芽征” Miliary nodles disease less common,Tree in bud appearance 鸟型分支杆菌（MAC） 真菌感染（Fungal infections） AIDS病人发生真菌感染并不常见 Uncommon in comparison with other infective disorders in AIDS 隐球菌最常见的肺部真菌病原体 Cryptococcus is the commonest pulmonary fungal pathogen in the AIDS population 脑膜炎是最常见的临床表现 Meningitis is the commonest manifestation of cryptococcal infection 肺是感染门户 Lung is thought to be the portal of entry CD4+细胞数量低于100×10-6 usually occur at patients with low CD4+ counts of less than 100×10-6 cells 典型：局部结节或空洞性结节，很少见。 Classical appearances:focal nodule formation,with or without cavitation,but less common 最常见：网状或结节状网格间质性渗出、肺泡实变、毛玻璃样改变、粟粒状结节、肿大淋巴结和少量胸腔积液。 Commonest radiological features:reticular or reticulonodular interstitial infiltrates,alveolar consolidation, ground-glass change, miliary nodules, lymphadenopathy and small pleural effusions 需与PJP、TB以及化脓性细菌感染相鉴别 Differential diagnosis of PJP, TB and pyogenic bacterial infections 曲霉菌(Aspergillus fumigatus) 好发于HIV感染后期深度免疫抑制的病人 uaually occur at Patients with profound immunosuppression 最常见表现：厚壁空洞，可有内壁肿块 Commonest radiographic findings: thick-walled cavities with or without an intracavitary mass 血管侵犯导致血管性梗塞 Haemorrhagic infarction as a result of angioinvasion 少见表现：结节和肺实变。 Less common findings: non-cavitating nodules and lung consolidation