Conces D J, Stockberger S M, Tarver R D, Wheat L J
Department of Radiology, Indiana University School of Medicine, Indianapolis 46202-5253.
AJR Am J Roentgenol. 1993 Jan;160(1):15-9. doi: 10.2214/ajr.160.1.8416614.
Our objective was to determine the findings of disseminated histoplasmosis on chest radiographs of patients with AIDS.
Chest radiographs of 50 AIDS patients with documented extrapulmonary histoplasmosis were analyzed retrospectively. The radiographs were evaluated for the presence of parenchymal opacities, pleural effusions, adenopathy, cavitation, and calcified granulomas and lymph nodes. A modification of the International Labour Office scheme was used to classify parenchymal abnormalities as nodular, linear or irregular, reticulonodular, or air-space opacities.
Abnormalities were present on radiographs in 23 patients. Nodular opacities were present in 10 patients and were diffusely distributed in nine patients. Linear or irregular opacities were present in seven patients, with diffuse distribution in four and limited involvement in three. Air-space opacities were present in seven patients; the distribution varied from segmental to diffuse involvement of the lung. Small pleural effusions were present in five patients. Adenopathy and Kerley's B lines were each present in three patients. In 27 patients, the chest radiographs were normal. Four of these patients had clinical or microbiological evidence of lung involvement.
The chest radiographic findings of disseminated histoplasmosis in AIDS patients are varied and nonspecific. The presence of diffuse nodular or linear/irregular opacities in an AIDS patient, especially one who resides in or has resided in an endemic area, should suggest the possibility of disseminated histoplasmosis. Normal findings on chest radiographs do not exclude disseminated infection or lung involvement.
我们的目的是确定艾滋病患者播散性组织胞浆菌病在胸部X光片上的表现。
对50例有肺外组织胞浆菌病记录的艾滋病患者的胸部X光片进行回顾性分析。评估X光片上是否存在实质模糊影、胸腔积液、淋巴结肿大、空洞形成以及钙化性肉芽肿和淋巴结。采用国际劳工组织方案的一种改良方法将实质异常分为结节状、线状或不规则状、网状结节状或气腔模糊影。
23例患者的X光片有异常表现。10例患者出现结节状模糊影，其中9例呈弥漫性分布。7例患者出现线状或不规则状模糊影，4例弥漫分布，3例累及范围有限。7例患者出现气腔模糊影；分布范围从肺段性到弥漫性累及不等。5例患者有少量胸腔积液。3例患者出现淋巴结肿大和克氏B线。27例患者的胸部X光片正常。其中4例患者有肺部受累的临床或微生物学证据。
艾滋病患者播散性组织胞浆菌病的胸部X光表现多样且无特异性。艾滋病患者出现弥漫性结节状或线状/不规则状模糊影，尤其是居住在或曾居住在流行地区的患者，应提示播散性组织胞浆菌病的可能性。胸部X光片正常并不能排除播散性感染或肺部受累。
