Xie Li-xuan, Liu Shi-yuan, Chen You-san, Liu Kai, Xue Feng
Department of Diagnostic Imaging, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Acta Radiol. 2011 Sep 1;52(7):743-9. doi: 10.1258/ar.2011.100455. Epub 2011 Apr 20.
Early detection and treatment of pulmonary fungal infection in immunocompromised patients has a profound impact on mortality. However, information available about the thin-section computed tomography (CT) findings of Candida pneumonia has largely been limited to isolated cases seen in reviews of various infections and to other acute lung diseases seen in immunocompromised patients.
To dynamically observe and evaluate CT findings in immunosuppressed animals with histopathologically confirmed pulmonary candidiasis at the acute stage.
Twenty-four New Zealand rabbits were randomly divided into an experimental group (n = 21) and a control group (n = 3). Pulmonary candidiasis was established by C. albicans inoculation via a transtracheal route in immunosuppressed rabbits in the experimental group, and an equivalent amount of normal saline was injected via the same way in the control group. Chest CT scan was performed before and on alternative days after inoculation/injection. Microbiological and pathological results were obtained by autopsy.
In the experiment group, pulmonary candidiasis was successfully established in 13 rabbits as confirmed by microbiology and pathology. Areas of air-space consolidation were present in 10 (10/13) rabbits, with lobular distribution in six and lobar or segmental distribution in four, pathologically presenting as bronchopneumonia or hemorrhagic lung infarcts. Areas of ground-glass opacity (GGO) were identified in five (5/13) rabbits, three of which were associated with other abnormalities, presenting as bronchopneumonia or interstitial pneumonitis. Multiple nodules were seen in three (3/13) rabbits. They were clustered around bronchovascular bundles in two rabbits, and subpleural in the remaining one, pathologically presenting as hemorrhagic granulomas. Other less common CT findings included thickening of bronchovascular bundles (n = 3), linear opacity (n = 1), and pneumothorax (n = 1). No abnormality was detected by CT scan and pathological examination in the three rabbits of the control group.
Peripheral multiple areas of lobular consolidation and/or GGO representing bronchopneumonia were the most common thin-section CT findings of pulmonary candidiasis at the early stage.
免疫功能低下患者肺部真菌感染的早期检测和治疗对死亡率有深远影响。然而，关于念珠菌肺炎的薄层计算机断层扫描（CT）表现的可用信息在很大程度上仅限于各种感染综述中所见的个别病例以及免疫功能低下患者中所见的其他急性肺部疾病。
动态观察和评估组织病理学证实为急性肺念珠菌病的免疫抑制动物的CT表现。
24只新西兰兔随机分为实验组（n = 21）和对照组（n = 3）。实验组通过经气管途径向免疫抑制的兔接种白色念珠菌建立肺念珠菌病，对照组通过相同方式注射等量生理盐水。接种/注射前及接种/注射后隔日进行胸部CT扫描。通过尸检获得微生物学和病理学结果。
实验组中，经微生物学和病理学证实，13只兔成功建立了肺念珠菌病。10只（10/13）兔出现气腔实变区，其中6只呈小叶分布，4只呈大叶或节段分布，病理表现为支气管肺炎或出血性肺梗死。5只（5/13）兔出现磨玻璃影（GGO），其中3只与其他异常相关，表现为支气管肺炎或间质性肺炎。3只（3/13）兔可见多发结节。其中2只兔的结节聚集在支气管血管束周围，另1只位于胸膜下，病理表现为出血性肉芽肿。其他较少见的CT表现包括支气管血管束增粗（n = 3）、线状影（n = 1）和气胸（n = 1）。对照组的3只兔CT扫描和病理检查均未发现异常。
代表支气管肺炎的外周多发小叶实变区和/或GGO是肺念珠菌病早期最常见的薄层CT表现。
