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Objective To investigate the CT findings of three types of pulmonary fungal disease in non-immunosuppressed patients. Methods We retrospectively collected 109 cases diagnosed with pulmonary fungal disease with pathological evidence which between January 2011 and October 2015 in the First Affiliated Hospital of Zhengzhou University, among which pulmonary aspergillosis were 48 cases, pulmonary cryptococcosis 45 cases and pulmonary mucormycosis 16 cases. Each patient underwent a chest MSCT scan. The data were analyzed that including underlying diseases, lesion types, lesion size, number, accompanying signs of CT scan, etc. χ2 test or Fisher exact test were used when compared underlying disease, lesion types, various of CT signs etc between different types of pulmonary fungal disease. Kruskal-Wallis H test were used when compared the incidence rate of lesions numbers and diameter. The ROC curve was used to analyze probability of predicting the fungal types by combined signs. Results The incidence of pulmonary mucormycosis with diabetes was higher than pulmonary aspergillosis and pulmonary cryptococcosis(χ2=2.704, 17.509, P<0.017) .The incidence of pulmonary mucormycosis with no underlying disease was lower than pulmonary aspergillosis and pulmonary cryptococcosis(Fisher test, P<0.017). Nodular or mass were main CT findings in the three pulmonary fungal disease. Consolidation, ground glass opacity and other manifestations were rare. Nodular or mass lesions in pulmonary aspergillosis accompany with CT signs like tree-in-bud, bronchogram sign, cavities, the air crescent sign, halo sign, the reversed-halo sign were rspectively 18, 10, 19, 10, 23, 0 cases;To pulmonary cryptococcosis were 4, 14, 6, 0, 11, 0 cases. To pulmonary mucormycosis were 2, 0, 4, 0, 4, 6 cases. Lesion number's distribution had a statistically difference between pulmonary aspergillosis and pulmonary cryptococcosis in nodular or mass lesions(P<0.05). Lesions size's distribution had statistically differences respectively between pulmonary mucormycosis and pulmonary aspergillosis, pulmonary cryptococcosis(P<0.05). Nodular lesions of pulmonary aspergillosis had higher incidence of tree-in-bud, cavity and air-crescent compared to pulmonary cryptococcosis(χ2=9.972,21.841,8.047,P<0.017). Reversed halo sign was mostly seen in pulmonary mucormycosis than in pulmonary aspergillosis and pulmonary cryptococcosis(Continuous correctionχ2=23.936,21.374, P<0.017). The area under the ROC curve for the combined signs predictive fungal disease type was 0.819. Conclusions Nodules or masses are the most common image findings in pulmonary aspergillosis, pulmonary cryptococcosis and pulmonary mucormycosis. The distribution of size and numbers and CT accompanied signs have a higher diagnostic efficacy in diagnosing and distinguishing pulmonary fungal disease.
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Objecfive To investigate multi-slice spiral CT(MSCT)appearances of pulmonary infections after liver transplantation(LT)and the diagnostic values of MSCT.Methods The clinical data and CT images of liver transplantation receptors were reviewed from 200 1 August to 2007 June,the types,onset time and CT appearances of pulmonary infections were analyzed retrospectively.Chi square test was used for the statistics.Results The incidence rate of pulmonary infections after LT was 32.9/(174/529),the mortality was 9.8/(1 7/174),The incidence of bacterial infection,fungus or associated fungus infection,and virus or associated virus infection were 17.2/(n=91),14.7/(n=78)and 2.3/(n=12)respectively,the pulmonary infections were seen in 64.7/,28.7/and 6.6/of patients 1 to 30 days,31-90 days and after 90 days following LT.Consolidations(n=32),ground-glass opacities(n=22),nodules(n=10),reticular or lineal opacities(n=4)were found in 45 patients who had CT examination,there were no statistic differences in incidence rate between bacterial infection and mycotic infection(P＞0.05).Conclusion Pulmonary bacterial and fungus infection are common after LT.and often present as the mixed infection,the high risk period for infection is within 30 days after LT,thoracic CT stall is very important for characterizing the pulmonary infections after LT.
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Objective To compare the thin-section CT findings of pulmonary candidiasis,aspergillosis and eryptococcosis wim histopathology in immunoeomprimised rabbits and impmve the diagnostic accuracy of fungus infection. Methods Heathy New Zealand white rabbits were used for immunoeompromised animal models.Thin-section CT scan was performed before and 2,4,6,8,10,12,14 d after inoculation.The pattern and distribution of the pulmonary abnormalities were retrospectively assessed by two thomeic radiologists and compared with histopathology.The granulocyte count was compared before and after administration of immunosuppressive agents.The pmred t test,chi square test and the Fisher's exact test were used for the statistics.Results Fourteen rabbits had candidiasis.16 rabbits had cryptocoecosis,15 rabbits had aspergillosis.The granulocyte counts before and after administration of immunosuppressive agents were(2.91±0.92)and(0.35±0.19)×109/L respectively in eandidiasis group,there was a significant difference(t=12.484,P＜0.05);(2.51±0.82)and(0.76±0.71)×109/L in aspergillosis group,there was a significant difference(t=5.792,P＜0.05);(2.10±0.65)and (0.48±0.22)×109/L in cryptococcosis group,there was a significant difference(t=8.199,P＜0.05).The onaet time of infections on CT were not significantly different in three groups (P＞0.05).Ground glass opacity (GGO) and consolidation were the two most colnlnon findings in immunocompromised rabbits with three fungus infections,areas of GGO was correlated with the congestion,hemorrhage,inflammatory cell infiltration and interstitial hyperplasia in pathology. Consolidation was correlated with the severe congestion,hemorrhage, inflammatory cell infiltration, interstitial hyperplasia, necrosis and vascular embolism in pathology. Conclusion GGO and consolidation are the two most common findings of fungus infections in immunocompromised animal models and thin-section CT findings can reflect the pathological changes.
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Objective To explore the risk factors of fungal lung infection in the elderly.Methods A retrospective analysis was carried out in 60 elderly patients with fungal lung infection admitted by Gulou Hospital Affiliated to Medial College of Nanjing University.The pathogenic bacteria and risk factors of fungal lung infection in the elderly were investigated.Results Candida albicans was the main pathogenic bacteria of fungal lung infection in the elderly,and the onset of fungal lung infection was probably related with the following factors: the existence of chronic background diseases,the application of antibiotics,hypoproteinemia,and the application of glucocorticoids.Conclusion Candida albicans is the main pathogenic bacteria of fungal lung infection in the elderly,and the existence of chronic background diseases,the application of antibiotics,hypoproteinemia and the application of glucocorticoids may be the independent risk factors of fungal lung infection in the elderly.Chinese medicine shows advantages for the treatment of fungal lung infection in the elderly.