Shirkhoda A, Lopez-Berestein G, Holbert J M, Luna M A
Radiology. 1986 May;159(2):349-53. doi: 10.1148/radiology.159.2.3961167.
Disseminated fungal disease, predominantly involving liver and spleen, developed in eight patients with hematologic malignancies. Because the patients failed to respond to standard antifungal drugs, they were treated with liposomal amphotericin B (L AmpB). Before therapy began, the diagnosis was confirmed histologically and the patients underwent abdominal computed tomography (CT), which indicated hepatosplenomegaly with or without multiple microabscesses in the liver and spleen. After each course of treatment with L AmpB, patients underwent CT, followed by either open or CT-guided percutaneous aspiration biopsy of the liver. Post-treatment CT showed partial regression of lesions in six patients and persistence in two. In all patients a liver biopsy confirmed that the lesions noted after treatment were due to granulomas or focal areas of fibrosis compatible with healing. Thus, the persistence of multiple defects on enhanced scans in two patients was not an indication of persistent abscesses. Clinical response was an additional important factor. Close clinical and pathologic correlation in addition to CT scanning are required in the follow-up of hepatosplenic fungal infections.
8例血液系统恶性肿瘤患者发生了以肝脏和脾脏为主的播散性真菌病。由于患者对标准抗真菌药物无反应，故采用脂质体两性霉素B（L AmpB）进行治疗。在治疗开始前，通过组织学检查确诊，患者接受了腹部计算机断层扫描（CT），结果显示肝脾肿大，肝脏和脾脏有或无多个微脓肿。每次使用L AmpB治疗后，患者均接受CT检查，随后对肝脏进行开放或CT引导下经皮穿刺活检。治疗后的CT显示，6例患者的病变部分消退，2例患者病变持续存在。所有患者的肝脏活检均证实，治疗后发现的病变是由肉芽肿或与愈合相符的局灶性纤维化区域引起的。因此，2例患者增强扫描中多个缺损的持续存在并非持续性脓肿的指征。临床反应是另一个重要因素。在肝脾真菌感染的随访中，除了CT扫描外，还需要密切的临床和病理相关性。
