Gosselin Marc V
Department of Radiology, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97201-3098, USA.
Semin Roentgenol. 2002 Jan;37(1):37-53. doi: 10.1053/sroe.2002.31834.
Physicians are encountering an increasing number of patients with various levels of immunosuppression, such as patients with AIDS, transplant recipients, patients on immunosuppressive therapy, and those with congenital immune defects and malignancy. This results in a greater diagnostic dilemma for the medical community because of the significant increased risk of opportunistic infections and noninfectious complications, as well as a more aggressive clinical course with typical pathogens. [figure: see text] Furthermore, it is not just the pathogens that are changing but also their clinical and radiographic presentations. The radiologist has a large role in not only detecting the presence of disease but also in narrowing the differential possibilities. This can be an overwhelming task given the wide variety of presentations of diseases on radiographs. However, by understanding the level and degree of the patient's immunosuppression, the radiologist may anticipate the most likely pulmonary complications. By using the radiographic morphology, distribution, and temporal evolution of the abnormalities, a manageable differential diagnosis can be created for referring clinicians.
医生们遇到越来越多具有不同免疫抑制水平的患者，例如艾滋病患者、移植受者、接受免疫抑制治疗的患者，以及患有先天性免疫缺陷和恶性肿瘤的患者。由于机会性感染和非感染性并发症的风险显著增加，以及典型病原体导致的临床病程更为凶险，这给医学界带来了更大的诊断难题。[图：见正文]此外，不仅病原体在发生变化，其临床和影像学表现也在改变。放射科医生不仅在检测疾病的存在方面发挥着重要作用，而且在缩小鉴别诊断的可能性方面也起着重要作用。鉴于X线片上疾病表现的多样性，这可能是一项艰巨的任务。然而，通过了解患者免疫抑制的水平和程度，放射科医生可以预测最可能出现的肺部并发症。通过利用异常的影像学形态、分布和时间演变，可以为转诊的临床医生制定一个可管理的鉴别诊断。
