Franquet Tomas, Rodriguez Sonia, Martino Rodrigo, Giménez Ana, Salinas Teresa, Hidalgo Alberto
Department of Radiology, Hospital de Sant Pau, Universitat Autónoma de Barcelona, Avda Sant Antoni Ma Claret 167, 08025 Barcelona, Spain.
AJR Am J Roentgenol. 2006 Oct;187(4):1085-90. doi: 10.2214/AJR.05.0439.
The purpose of this study was to use serial thin-section CT scans to assess the incidence of respiratory viral infection and lung abnormalities in a large patient population at high risk of pulmonary complications.
The study population consisted of 26 recipients of hematopoietic stem cell transplants who had proven respiratory viral pneumonia. In all cases, thin-section CT scans were obtained before fiberoptic bronchoscopy and bronchoalveolar lavage. The study included only patients in whom bronchoalveolar lavage fluid showed no evidence of organisms other than respiratory viruses. The CT scans were assessed for the presence, extent, and anatomic distribution of ground-glass attenuation, air-space consolidation, nodules, centrilobular branching structures (tree-in-bud), thickening of the bronchovascular bundles, and pleural effusion.
Areas of ground-glass attenuation were identified in 24 (92%) of 26 patients and were the only finding in eight patients. Multiple nodules, seen in 17 (65%) of 26 patients, measured 3-10 mm in diameter or were larger than 10 mm. The nodules had a centrilobular or random distribution. A tree-in-bud appearance was seen in six of the patients with centrilobular nodules. This pattern had a bilateral distribution and involved mainly the lower lung zones. CT revealed thickening of the bronchovascular bundles in 16 (61%) of the patients. Thickening was bilateral in 14 and unilateral in two patients. Bronchial wall thickening involved the lower lobes in six patients and had a patchy random distribution in the remaining nine patients. Air-space consolidation was present in nine (35%) of the cases. It had a lobular or subsegmental distribution in eight of the patients and a segmental distribution in one patient. Areas of consolidation were randomly distributed throughout the lungs in all cases. Less common findings included bilateral pleural effusion and bronchial dilatation.
Respiratory viral infection is common among adult recipients of hematopoietic stem cell transplants, occurring over a wide time span after transplantation. The presence of respiratory viral infection must be considered in any patient with new respiratory symptoms, fever, or findings at CT such as extensive or patchy areas of ground-glass opacities or a mixture of patterns, most commonly ground-glass attenuation, thickening of the bronchial walls, and multiple small nodules.
本研究的目的是使用系列薄层CT扫描来评估肺部并发症高风险的大量患者群体中呼吸道病毒感染和肺部异常的发生率。
研究人群包括26例已证实患有呼吸道病毒性肺炎的造血干细胞移植受者。所有病例均在纤维支气管镜检查和支气管肺泡灌洗前进行薄层CT扫描。该研究仅纳入支气管肺泡灌洗液除呼吸道病毒外未显示其他生物体证据的患者。对CT扫描评估磨玻璃影、实变、结节、小叶中心分支结构（树芽征）、支气管血管束增厚和胸腔积液的存在、范围及解剖分布。
26例患者中有24例（92%）发现磨玻璃影区域，其中8例患者仅见此表现。26例患者中有17例（65%）可见多个结节，直径3 - 10毫米或大于10毫米。结节呈小叶中心性或随机分布。6例有小叶中心性结节的患者可见树芽征表现。此模式呈双侧分布，主要累及下肺区。CT显示16例（61%）患者支气管血管束增厚。14例双侧增厚，2例单侧增厚。6例患者支气管壁增厚累及下叶，其余9例呈散在随机分布。9例（35%）病例存在实变。8例患者呈小叶或亚段分布，1例呈段性分布。所有病例中实变区域随机分布于全肺。较少见的表现包括双侧胸腔积液和支气管扩张。
呼吸道病毒感染在造血干细胞移植成年受者中很常见，发生在移植后的很长一段时间内。任何出现新的呼吸道症状、发热或CT表现如广泛或散在的磨玻璃影区域或多种模式混合（最常见的是磨玻璃影、支气管壁增厚和多个小结节）的患者都必须考虑呼吸道病毒感染的存在。
