Zheng Yu-long, Wang Xue-fen, Ding Wei, Zhou Jian-ying
Department of Respiratory Disease, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2006 Feb;29(2):92-5.
The purpose of this study was to describe the approaches to the diagnosis and the treatment of chronic necrotizing pulmonary aspergillosis (CNPA).
The study included 8 patients with CNPA confirmed by histopathological studies. The patients were admitted to the First Affiliated Hospital of College of Medicine of Zhejiang University during 2000-2004. The clinical data were analyzed, and related literature was reviewed. The clinical, radiological and pathological characteristics, and the approaches to the diagnosis and the treatment were described.
CNPA was a rare form of pulmonary aspergillosis. Common presentations included productive cough (8/8), haemoptysis (7/8) and constitutional symptoms (5/8). Radiographically, the air crescent sign was suggestive of the diagnosis, which was found in 4 patients. Consolidation was also common in the other 4 cases. The histological feature of CNPA included the presence of tissue invasion by Aspergillus, tissue necrosis and granulomatous inflammation.
The clinical manifestations of CNPA are non-specific. Radiography plays a pivotal role in the diagnosis of CNPA. Treatment with antifungal medications is indicated once the diagnosis is made. Pulmonary resection should be considered when patients have prolonged illness or frequent haemoptysis.
本研究旨在描述慢性坏死性肺曲霉病（CNPA）的诊断和治疗方法。
本研究纳入了8例经组织病理学检查确诊为CNPA的患者。这些患者于2000年至2004年期间入住浙江大学医学院附属第一医院。对临床资料进行分析，并复习相关文献。描述了其临床、影像学和病理学特征，以及诊断和治疗方法。
CNPA是肺曲霉病的一种罕见形式。常见表现包括咳痰（8/8）、咯血（7/8）和全身症状（5/8）。影像学上，空气新月征提示诊断，4例患者出现此征。另外4例患者常见实变。CNPA的组织学特征包括曲霉菌组织侵袭、组织坏死和肉芽肿性炎症。
CNPA的临床表现不具特异性。影像学在CNPA的诊断中起关键作用。一旦确诊，应使用抗真菌药物治疗。当患者病程延长或频繁咯血时，应考虑肺切除术。
