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1、成年人巨细胞病毒性肺炎 影像学及病理学表现,胸组读片 2010-03-02 刘晶华,Case,Name：Me Ping Sex：Female Age：46 P No.：P10044471,Case,Examine Date 2009-08-17 Thin-section (1-mm collimation) computed tomographic (CT) scan shows Bilateral diffuse ground-glass attenuation with thickened interlobular septa, and A lobular distribution, se
2、gmental consolidation with the “inflated bronchia” sign. There are several lymph nodes in the mediastina. No pleural effusion. The heart, liver, spleen and other scanned areas are normal.,Case,Diagnosis: Bilateral diffuse lesion of lung, considered as infection. Differentiate Diagnosis： (1)Viral pne
3、umonia(CMV,EBV) (2)PCP (3) Chlamydia pneumonia,成年人病毒性肺炎,流感病毒、麻疹病毒、汉坦病毒、腺病毒、单纯疱疹病毒、水痘-带状疱疹病毒、巨细胞病毒以及EB病毒等多种病毒能够引起成年人下呼吸道感染。 成年人病毒性肺炎可分为两种类型：发生于健康宿主的非典型性肺炎 ；发生于免疫缺陷宿主的病毒性肺炎。,免疫正常及免疫缺陷患者常见的病毒感染,免疫正常患者 流感病毒 汉坦病毒 EB病毒 腺病毒,免疫缺陷患者 单纯疱疹病毒 水痘-带状疱疹病毒 巨细胞病毒 麻疹病毒 腺病毒,成年人病毒性肺炎,影像学表现多种多样且相互重叠。 患者年龄、免疫状况、社区性爆发、起病状
4、况、严重程度及持续时间、有无发疹等临床信息对于诊断具有重要帮助。 实验室检查,常见的病理学表现,病毒能够引起：气管支气管炎，细支气管炎，肺炎。 上皮细胞及相邻间质组织学改变最为显著。,常见的病理学表现,气管支气管炎：气道壁充血，管腔内单核细胞浸润 ，上皮细胞变性、脱落。 细支气管炎： 儿童常见，上皮细胞坏死，管腔内嗜中性粒细胞渗出，气道壁内单核细胞为主的炎性细胞浸润。,常见的病理学表现,实质受累（肺炎）：终末及呼吸性细支气管相邻肺组织首先受累， 可进展至整个肺叶。 老年及免疫缺陷患者可发生快速进展的肺炎。 组织学上，双肺弥漫性肺泡破坏（间质淋巴细胞浸润，气腔内出血，水肿及纤维蛋白渗出，2型肺泡
5、上皮增生，透明膜形成）,Photomicrograph (original magnification, 100; hematoxylin-eosin stain) of a lung biopsy specimen from a 36-year-old man with pneumonia due to herpes simplex virus type 1 shows a fibrous exudate (large arrows) along the alveolar walls. Note the interstitial thickening due to fibroblastic
6、proliferation (small arrows).,常见的影像学表现,气管支气管炎：急性期很少出现异常影像学改变，但多年后粘膜破坏可表现为支气管扩张。 细支气管炎：气道阻塞常为不完全性，影像学上表现为过度通气及边界不清的结节灶。,常见的影像学表现,病毒性肺炎： 边界不清的结节（4-10mm的气腔内结节）。 细支气管周围斑片状磨玻璃密度及气腔实变。 常伴有过度通气。 快速进展型肺炎：实变区快速融合，引起弥漫性肺泡损害（均一性或斑片状单侧或双侧气腔内实变，以及磨玻璃密度灶或界限不清的小叶核心结节）。,Photomicrograph (original magnification, 100;
7、 hematoxylin-eosin stain) of a lung biopsy specimen from a 36-year-old man with pneumonia due to herpes simplex virus type 1 shows a fibrous exudate (large arrows) along the alveolar walls. Note the interstitial thickening due to fibroblastic proliferation (small arrows).,Photomicrograph (original m
8、agnification, 100; hematoxylin-eosin stain) of a lung biopsy specimen from a 36-year-old man with pneumonia due to herpes simplex virus type 1 shows a fibrous exudate (large arrows) along the alveolar walls. Note the interstitial thickening due to fibroblastic proliferation (small arrows).,Photomicr
9、ograph (original magnification, 100; hematoxylin-eosin stain) of a lung biopsy specimen from a 36-year-old man with pneumonia due to herpes simplex virus type 1 shows a fibrous exudate (large arrows) along the alveolar walls. Note the interstitial thickening due to fibroblastic proliferation (small
10、arrows).,Pneumonia due to influenza virus (type C) in a 46-year-old man with dyspnea. Initial chest radiograph shows diffuse reticulonodular areas of increased opacity in both lungs.,Pneumonia due to influenza virus (type C) in a 46-year-old man with dyspnea. Follow-up chest radiograph obtained 15 d
11、ays later shows progression of the extent of disease with diffuse consolidation throughout both lungs.,Pneumonia due to influenza virus (type C) in a 46-year-old man with dyspnea. (a) Initial chest radiograph shows diffuse reticulonodular areas of increased opacity in both lungs. (b) Follow-up chest
12、 radiograph obtained 15 days after a shows progression of the extent of disease with diffuse consolidation throughout both lungs. (c) Thin-section (1-mm collimation) computed tomographic (CT) scan obtained 16 days after a at the level of the aortic arch shows diffuse ground-glass attenuation with so
13、me irregular linear areas of increased attenuation in both lungs. (Case courtesy of Dr Jung Hwa Hwang, Soonchunhyang University Seoul Hospital, Korea.),Pneumonia due to influenza virus (type C) in a 46-year-old man with dyspnea. (a) Initial chest radiograph shows diffuse reticulonodular areas of inc
14、reased opacity in both lungs. (b) Follow-up chest radiograph obtained 15 days after a shows progression of the extent of disease with diffuse consolidation throughout both lungs. (c) Thin-section (1-mm collimation) computed tomographic (CT) scan obtained 16 days after a at the level of the aortic ar
15、ch shows diffuse ground-glass attenuation with some irregular linear areas of increased attenuation in both lungs. (Case courtesy of Dr Jung Hwa Hwang, Soonchunhyang University Seoul Hospital, Korea.),Pneumonia due to influenza virus (type C) in a 46-year-old man with dyspnea. (a) Initial chest radi
16、ograph shows diffuse reticulonodular areas of increased opacity in both lungs. (b) Follow-up chest radiograph obtained 15 days after a shows progression of the extent of disease with diffuse consolidation throughout both lungs. (c) Thin-section (1-mm collimation) computed tomographic (CT) scan obtained 16 days after a at the level of the aortic arch shows diffuse ground-glass attenuation with some irregular linear areas of increased attenuation in both lungs. (
