Lee L N, Yang P C, Kuo S H, Luh K T, Chang D B, Yu C J
Department of Clinical Pathology, National Taiwan University Hospital, Taipei.
Thorax. 1993 Jan;48(1):75-8. doi: 10.1136/thx.48.1.75.
Ultrasound is useful for locating thoracic lesions and guiding biopsy procedures. The use of sonographic appearances and ultrasound guided needle aspiration has led to the diagnosis of pulmonary cryptococcosis at this hospital.
Six hundred and eight patients who had ultrasound guided lung aspirations were reviewed retrospectively and nine with documented pulmonary cryptococcosis were collected. All patients had nodules or infiltrates on the chest radiograph. The needle aspirates obtained under ultrasound guidance were stained by Riu's or Papanicolaou's method or with India ink, and six were sent for culture. Five patients also underwent bronchoscopy and biopsy.
The nine patients had 18 pulmonary lesions, of which 15 were nodules and three infiltrates. Fifteen lesions were detectable by ultrasound, which showed the nodules to be hypoechoic with eccentrically located air echoes. In eight of the nine cases cryptococci were detected after the lung aspirates had been stained with Riu's or Papanicolaou stain or with India ink. In five of the six aspirates sent for fungal culture Cryptococcus neoformans was isolated. The diagnostic yield was higher than that of bronchoscopy. None developed post-aspiration pneumothorax or any evidence of late dissemination.
Because they tend to be subpleural pulmonary cryptococcal lesions seem to be identifiable by ultrasound. Ultrasound guided lung aspiration is an effective, rapid, and safe method for diagnosis.
超声有助于定位胸部病变并指导活检操作。超声表现及超声引导下针吸活检已使本院诊断出肺隐球菌病。
回顾性分析608例行超声引导下肺穿刺的患者，收集9例有记录的肺隐球菌病患者。所有患者胸部X线片均有结节或浸润影。超声引导下获取的针吸组织采用瑞氏或巴氏染色或墨汁染色，6例送检培养。5例患者还接受了支气管镜检查及活检。
9例患者有18个肺部病变，其中15个为结节，3个为浸润影。15个病变可通过超声检测到，结节表现为低回声，内见偏心分布的气体回声。9例中的8例在肺穿刺组织经瑞氏或巴氏染色或墨汁染色后检测到隐球菌。6例送检真菌培养的针吸组织中有5例分离出新型隐球菌。诊断阳性率高于支气管镜检查。无一例发生穿刺后气胸或任何晚期播散的证据。
肺隐球菌病病变多位于胸膜下，似乎可通过超声识别。超声引导下肺穿刺是一种有效、快速且安全的诊断方法。
