Zizzo G, Melillo L, Cammisa M, Carotenuto M
Dipartimento di Diagnostica per Immagini, Ospedale Generale Regionale IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia.
Radiol Med. 1994 Apr;87(4):435-40.
Invasive pulmonary aspergillosis (IPA) in the presence of hematologic malignancies is an increasingly common condition characterized by high morbidity and mortality. Plain chest films are a valuable tool for diagnosis but the radiologist must be familiar with the morphological features of the disease to interpret radiographic abnormalities and to differentiate IPA from opportunistic pneumonia. The chest films of 16 leukemia and IPA patients performed from January 1987 to September 1993 were reviewed. The natural course of infection from its early stage (nodular lesions) to the subsequent phases when eventual medullary recovery plays a critical role was thus traced. Our major finding was related to the histogenesis of primary pulmonary lesions: the most common features we observed--i.e., the spherical rather than triangular shape of necrosis areas, with no relationship to the pleura or scissural delimitation suggest that supposed ischemia from vascular infiltration cannot be the only pathogenetic factor of pulmonary injury, in spite of the well-known angioinvasivity of the fungus Aspergillus.
血液系统恶性肿瘤患者并发的侵袭性肺曲霉病（IPA）愈发常见，其特点是高发病率和高死亡率。胸部X线平片是诊断的重要工具，但放射科医生必须熟悉该疾病的形态学特征，以便解读影像学异常并鉴别IPA与机会性肺炎。回顾了1987年1月至1993年9月期间16例白血病合并IPA患者的胸部X线平片。由此追踪了感染从早期（结节性病变）到随后阶段（最终骨髓恢复起关键作用）的自然病程。我们的主要发现与原发性肺部病变的组织发生有关：我们观察到的最常见特征——即坏死区域呈球形而非三角形，与胸膜或裂隙界限无关，这表明尽管曲霉菌具有众所周知的血管侵袭性，但血管浸润导致的所谓缺血不可能是肺损伤的唯一致病因素。
