Kyorin University School of Medicine, Department of Respiratory Medicine, Mitaka, Tokyo, Japan;
J Thorac Dis. 2012 Dec;4(6):577-82. doi: 10.3978/j.issn.2072-1439.2012.11.07.
Opportunistic pulmonary infection with Nocardia species is rare in humans, and only a few studies have radiologically analyzed patients with pulmonary nocardiosis using high-resolution computed tomography (HRCT).
We retrospectively reviewed the medical records of patients with pulmonary nocardiosis at our hospital between April 2006 and December 2011 to assess HRCT and clinical findings. We also searched the medical literature for pulmonary nocardiosis reported in Japan between 2002 and 2011 for comparison.
We identified seven patients at our institution and 33 reported infections in Japan. Four of our patients were immunocompetent, whereas the other three had impaired cellular immunity due to type 2 diabetes mellitus or having been inappropriately treated with steroid. Thoracic HRCT revealed no zonal predominance, but tropism for distribution from the middle to the peripheral area, and radiological findings of nodules, cavitation, mass, consolidations, bronchial wall thickening, septal line thickening and ground glass opacity (GGO) were evident. The main HRCT finding in our study comprised nodules (n=5, 71.4%) <30 mm and four patients had multiple nodules as described in other reports. Furthermore, we discovered a crazy paving appearance (CPA) around nodules, cavities, masses or consolidations in five patients (71.4%).
Multiple nodules distributed from the middle to the peripheral area on HRCT might reflect pulmonary nocardiosis, and CPA seemed to be a worth paying attention to the diagnosis.
人类感染奴卡氏菌属是一种机会性肺部感染，仅有少数研究使用高分辨率计算机断层扫描（HRCT）对肺部奴卡氏菌病患者进行了影像学分析。
我们回顾性分析了 2006 年 4 月至 2011 年 12 月期间我院肺部奴卡氏菌病患者的病历，评估了 HRCT 和临床发现。我们还在日本 2002 年至 2011 年期间发表的肺部奴卡氏菌病文献中进行了检索，以作比较。
我们在本院发现了 7 例患者，在日本共发现了 33 例报道的感染。我们的 4 例患者免疫功能正常，而另外 3 例因 2 型糖尿病或不适当使用类固醇而存在细胞免疫功能受损。胸部 HRCT 显示无区域性优势，但分布有从中部向周边的趋势，且存在结节、空洞、肿块、实变、支气管壁增厚、间隔线增厚和磨玻璃密度影（GGO）等影像学表现。我们的研究中主要的 HRCT 表现为<30mm 的结节（n=5，71.4%），4 例患者存在多个结节，这与其他报道中的描述一致。此外，我们发现 5 例患者（71.4%）的结节、空洞、肿块或实变周围存在铺路石样外观（CPA）。
HRCT 上从中部到周边分布的多个结节可能反映了肺部奴卡氏菌病，CPA 似乎是值得关注的诊断特征。
