Giacomelli Irai Luis, Schuhmacher Neto Roberto, Nin Carlos Schuller, Cassano Priscilla de Souza, Pereira Marisa, Moreira José da Silva, Nascimento Douglas Zaione, Hochhegger Bruno
. Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre (RS) Brasil.
J Bras Pneumol. 2017 Jul-Aug;43(4):270-273. doi: 10.1590/S1806-37562016000000306.
Respiratory infections constitute a major cause of morbidity and mortality in solid organ transplant recipients. The incidence of pulmonary tuberculosis is high among such patients. On imaging, tuberculosis has various presentations. Greater understanding of those presentations could reduce the impact of the disease by facilitating early diagnosis. Therefore, we attempted to describe the HRCT patterns of pulmonary tuberculosis in lung transplant recipients.
From two hospitals in southern Brazil, we collected the following data on lung transplant recipients who developed pulmonary tuberculosis: gender; age; symptoms; the lung disease that led to transplantation; HRCT pattern; distribution of findings; time from transplantation to pulmonary tuberculosis; and mortality rate. The HRCT findings were classified as miliary nodules; cavitation and centrilobular nodules with a tree-in-bud pattern; ground-glass attenuation with consolidation; mediastinal lymph node enlargement; or pleural effusion.
We evaluated 402 lung transplant recipients, 19 of whom developed pulmonary tuberculosis after transplantation. Among those 19 patients, the most common HRCT patterns were ground-glass attenuation with consolidation (in 42%); cavitation and centrilobular nodules with a tree-in-bud pattern (in 31.5%); and mediastinal lymph node enlargement (in 15.7%). Among the patients with cavitation and centrilobular nodules with a tree-in-bud pattern, the distribution was within the upper lobes in 66.6%. No pleural effusion was observed. Despite treatment, one-year mortality was 47.3%.
The predominant HRCT pattern was ground-glass attenuation with consolidation, followed by cavitation and centrilobular nodules with a tree-in-bud pattern. These findings are similar to those reported for immunocompetent patients with pulmonary tuberculosis and considerably different from those reported for AIDS patients with the same disease.
呼吸道感染是实体器官移植受者发病和死亡的主要原因。此类患者中肺结核的发病率很高。在影像学上，肺结核有多种表现形式。对这些表现有更深入的了解有助于早期诊断，从而降低该疾病的影响。因此，我们试图描述肺移植受者肺结核的高分辨率计算机断层扫描（HRCT）模式。
我们从巴西南部的两家医院收集了以下有关发生肺结核的肺移植受者的数据：性别、年龄、症状、导致移植的肺部疾病、HRCT模式、检查结果分布、从移植到患肺结核的时间以及死亡率。HRCT检查结果分为粟粒结节、空洞形成以及伴有树芽征的小叶中心结节、磨玻璃影合并实变、纵隔淋巴结肿大或胸腔积液。
我们评估了402名肺移植受者，其中19人在移植后发生了肺结核。在这19名患者中，最常见的HRCT模式是磨玻璃影合并实变（42%）；空洞形成以及伴有树芽征的小叶中心结节（31.5%）；纵隔淋巴结肿大（15.7%）。在有空洞形成以及伴有树芽征的小叶中心结节的患者中，66.6%的病变分布在上叶。未观察到胸腔积液。尽管进行了治疗，一年死亡率仍为47.3%。
主要的HRCT模式是磨玻璃影合并实变，其次是空洞形成以及伴有树芽征的小叶中心结节。这些发现与免疫功能正常的肺结核患者的报告结果相似，与艾滋病合并肺结核患者的报告结果有很大不同。
Zotero 插件