Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, China.
Medicine (Baltimore). 2024 Jun 28;103(26):e38671. doi: 10.1097/MD.0000000000038671.
The aim of this study is to delineate the distinctive high-resolution computed tomography features of pulmonary cryptococcosis in non-HIV-infected patients. This retrospective analysis encompasses high-resolution computed tomography scans from 58 patients with histologically confirmed pulmonary cryptococcosis, focusing on the diagnostic challenges and the factors that lead to misdiagnosis. Analysis of computed tomography scans from these patients indicated that nodular or mass-like presentations were evident in 32 cases (55.2%), consolidation presentations in 7 cases (12.1%), and mixed presentations in 19 cases (32.8%). Lesions were predominantly located in the lower lobes of the lungs (40 cases, 69.0%) and in peripheral zones (55 cases, 94.8%). Notable radiographic signs included the presence of the burr sign in 55 cases (94.8%), lobulation sign in 53 cases (91.4%), halo sign in 53 cases (91.4%), and air bronchogram in 46 cases (79.0%). Moreover, 24 cases (41.4%) exhibited necrosis or cavitation, mediastinal lymphadenopathy was noted in 6 cases (10.3%), and pleural effusion was present in 5 cases (8.6%). Lesions were devoid of calcification. Pulmonary cryptococcosis ought to be contemplated in the differential diagnosis when computed tomography imaging exhibits patterns including, but not limited to, lower lobe and peripheral distribution, a broad base abutting the pleura, clustered growth with a propensity for fusion, air bronchogram within lesions, and peripheral halo sign.
本研究旨在描绘非 HIV 感染患者肺部隐球菌病的高分辨率计算机断层扫描(computed tomography,CT)特征。该回顾性分析纳入了 58 例经组织学证实的肺部隐球菌病患者的高分辨率 CT 扫描,重点关注诊断挑战和导致误诊的因素。对这些患者的 CT 扫描进行分析后表明,32 例(55.2%)表现为结节或肿块样,7 例(12.1%)为实变样,19 例(32.8%)为混合样。病变主要位于肺下叶(40 例,69.0%)和外周区(55 例,94.8%)。显著的影像学征象包括:55 例(94.8%)存在晕征,53 例(91.4%)存在分叶征,53 例(91.4%)存在晕环征,46 例(79.0%)存在空气支气管征。此外,24 例(41.4%)存在坏死或空洞,6 例(10.3%)存在纵隔淋巴结病,5 例(8.6%)存在胸腔积液。病变无钙化。当 CT 成像表现为以下模式时,应考虑肺部隐球菌病的鉴别诊断,包括但不限于:下叶和外周分布、与胸膜宽基底相贴、呈簇状生长并倾向融合、病变内有空气支气管征以及外周晕环征。