Cecconi L, Busi Rizzi E, Mazzuoli G, Schininà V
Servizio di Radiologia, Ospedale L. Spallanzani, USL RM 10, Roma.
Radiol Med. 1994 May;87(5 Suppl 2):34-51.
Over the last decade the number of subjects with acquired immunodeficiencies has markedly increased; this phenomenon depends on both the large number of patients receiving organ transplants or antiblastic therapy and the spread of infections caused by the HIV virus. In 70-90% of these patients primary diseases include different pulmonary infections, relative to the type and degree of immune compromission. Pathogenic or, in most cases, opportunistic germs are responsible for severe pneumonia whose mortality rate can top 50%. Since prognosis depends on the promptness of treatment, the diagnosis of nature must be made quickly by integrating clinical and diagnostic findings with laboratory and instrumental results. Conventional chest radiology plays a major role as the first step in a diagnostic iter which can now include rather sensitive techniques--e.g., equalized chest films. CT and nuclear medicine often represent the necessary diagnostic complements but, in some cases, etiology can be diagnosed only with such invasive procedures as lung biopsy. The authors reviewed the current data on the diagnostic imaging findings of pulmonary infections caused by common germs, by Pneumocystis carinii mycobacteria, mycetes and viruses in immunocompromised patients, integrating their personal experience with literature data.
在过去十年中,获得性免疫缺陷患者的数量显著增加;这一现象既归因于接受器官移植或抗恶性肿瘤治疗的患者数量众多,也归因于由艾滋病毒引起的感染的传播。在这些患者中,70%至90%的原发性疾病包括不同类型的肺部感染,这与免疫功能受损的类型和程度有关。致病性病菌或在大多数情况下的机会性病菌是导致严重肺炎的原因,其死亡率可能超过50%。由于预后取决于治疗的及时性,因此必须通过将临床和诊断结果与实验室及仪器检查结果相结合,迅速做出病因诊断。传统的胸部X线检查作为诊断流程的第一步起着重要作用,现在这一流程还可包括相当敏感的技术,如胸部平片。CT和核医学检查常常是必要的诊断补充手段,但在某些情况下,只有通过肺活检等侵入性检查才能诊断病因。作者结合自身经验和文献资料,综述了免疫功能低下患者中由常见病菌、卡氏肺孢子虫、分枝杆菌、真菌和病毒引起的肺部感染的诊断影像学检查结果的现有数据。