艾湘病相关胸部疾病的影像诊断ImagingofthethoraxinAIDS上海复旦大学附属公共卫生临床中心Shanghaiaffiliatedpublichealthcentre施裕新张志勇王桂龙Shiyuxinzhangzhiyongwangguilong背景Background本发病率,大多数,新AIDS50%Morbidity:50%5ofnewAIDSpresentation本意义:致病率和死亿率的重要原因Meaning:,importantause.ofmorbidityandmortality本新特点:1.治疗抗病毒和预防性抗生素Newfeature:Tharapycombinationantiretroviraltherapyandtheuseofprophylacticantibiotics2病原体传统(PJP),少见(巨毒及鸟分菌丫)Pathogentradition(PJPJ小lesscommon(CMVandMAC)个3.人群妇女、儿童个Populationcharacteristicswomenandchildren个背景Background4.影像:多样,重叙Radiologicalappearances:varietyandoverlap5.影像结合临床:ImagingbeinterpretedinconjuctionwithclinicallnfDnnat10n获得背景,并发症,CD4+细胞数,治疗缓急程度血氧分析和疸菌培养李NatureofHIVacquisition,previousinfectionsornon-infectionscomplications,CD4+cellcount,currentdrugtherapy,andacutenessofonsetandseverityoftheilIness,PulseoximetryandsputummicroscopyCD4细胞计数与肺部并发;004维胭计数(X106个/)动部痴原仰(科类、表现)2200绍节性肽奕结核(绰发性)劭癖50-200绍伯性脱奕结核(原发性)脉痛mE胎U消n“郭真荣怡朱马形体瘀杆节性山管痴疲200BacterialpeumoniTBeinfeetion)TB(primay)LangcarcinomaPCPKSLymphomaFungalinfectionsTFominqdiBaciiinntidmiosis50BacterialeumoniaTBfaypicalappeannce)LangcarcinomaPCPKSDymptomaFungalinfecionsToxoplamostsBacilaryangionaosiMACCMVTBTuberculosisiPCBPeumoeystiseariilpaeumoiaiKSKaposissarcomaiMAC,MycobacieumaMumcomplex:CMVcylomegaloyrus-影像价值TheroleofCT确定病变Confirmingsuspectedchestdisease木监别诊断Differentialdiagngsis丨活检或胸腔引流AdvisingonandperformingthoracicinterventionsSucha5biopsyorchestdrainage疗效检测及随访Monitoringtheresponsetotherapyfollowingdiagnosis吉CT?普通胸片CTissuperiortoplainchestradiography“CT确诊率不高,约50%AccuracyofCTinthediagnosisofthoraciecomplicationsofAIDSowabout09“确定税变儿胸片?以Confinmingsuspectedchestdisease吊定性诊断Clarificationofabnormalitiesidentifiedonplainchestradiographs“病变范围和形态Theextentofdiseaseandthepatternofparenchymalchange吊纵隔异常Evaluationofmediastinalabnormalities肿痤分期或随访Stagingofmalignantdiseaseorre-stagingposttherapy“指导活检、胸胺积波和气胸引流Biopsyplanningdrainingofloculatedpleuralfluidcollections卡氏肺孢子菌肺炎(Pheumocystisjirovecipneumonia)“PJP是最常见呼吸道感染PJPwasthecommonestrespiratorytractinfectiontooccurinheAIDSpopulation“预防用药提高预期明命,细菌性肺炎仁Prophylacticpreventativetherdpyincreaselifeexpectancy,bacterialpneumoniasuperseded“进行性咳嗽和发热、低氧表现Historyofcoughandfever,hypoxicdevelopingoverseveraldays“疲标本、活检Inducedsputumsample,BAL.transbronchialbiopsyX线典型:Chestradiograph:两侧肺门分布毛玻璃或网格状浸涧Bilateralground-glassorTeticularinfiltratesmostmarkedinaperihilardistribution卡氏肺孢子菌肺炎(Pheumocystiscariniipneumonia)0CT本(1肺门周围毛玻璃样浸润,地图样分布Perihilarground-glassinfiltrat,geographicaldistribution丰2)线状或网格状伴有小叶间隔增厚一一吸收较慢Alinearorreticularinterstitialpatternwiththickeningoftheinterlobularseptae-slowesttoTesolye