Poulton T B
Aultman Hospital, Canton, Ohio.
Am Fam Physician. 1992 Jan;45(1):163-8.
Chest radiographs, computed tomography and gallium scanning are useful in diagnosing the pulmonary manifestations of acquired immunodeficiency syndrome. Most opportunistic infections in patients with AIDS affect the lung as the primary target organ. Bilateral perihilar or basilar interstitial infiltrates, which may progress to the ground-glass appearance of adult respiratory distress syndrome, are commonly seen in cases of Pneumocystis carinii pneumonia. Unilateral or miliary infiltrates and cavitary lesions may be atypical presentations. Diffuse interstitial infiltrates are also seen in mycobacterial, fungal and cytomegalovirus infections. Mycobacterium tuberculosis infection in AIDS patients resembles primary tuberculosis infection rather than secondary tuberculosis reactivation. Intrathoracic adenopathy in AIDS patients suggests neoplastic processes, such as lymphoma and Kaposi's sarcoma, and opportunistic infections such as M. tuberculosis, Mycobacterium avium-intracellulare and fungal infections. Bronchoscopy with bronchoalveolar lavage and transbronchial biopsy are usually necessary for identification of the etiologic agent.
胸部X光片、计算机断层扫描和镓扫描对诊断获得性免疫缺陷综合征的肺部表现很有用。艾滋病患者的大多数机会性感染以肺部作为主要靶器官。卡氏肺孢子虫肺炎病例中常见双侧肺门周围或基底间质性浸润，可进展为成人呼吸窘迫综合征的磨玻璃样表现。单侧或粟粒样浸润以及空洞性病变可能是非典型表现。在分枝杆菌、真菌和巨细胞病毒感染中也可见弥漫性间质性浸润。艾滋病患者的结核分枝杆菌感染类似于原发性结核感染，而非继发性结核复发。艾滋病患者的胸内淋巴结肿大提示存在肿瘤性病变，如淋巴瘤和卡波西肉瘤，以及机会性感染，如结核分枝杆菌、鸟分枝杆菌复合群和真菌感染。通常需要进行支气管镜检查、支气管肺泡灌洗和经支气管活检以确定病原体。
