成年人巨細(xì)胞病毒性肺炎ppt課件

1、成年人巨細(xì)胞病毒性肺炎——影像學(xué)及病理學(xué)表現(xiàn)1CaseName：MePingSex：FemaleAge：46PNo.：P100444712CaseExamineDate20090817Thinsection(1mmcollimation)computedtomographic(CT)scanshowsBilateraldiffusegroundglassattenuationwiththickenedinterlobularseptaA

2、lobulardistributionsegmentalconsolidationwiththe“inflatedbronchia”sign.Thereareseverallymphnodesinthemediastina.Nopleuraleffusion.Theheartliverspleenotherscannedareasarenmal.3CaseDiagnosis:Bilateraldiffuselesionoflungcon

3、sideredasinfection.DifferentiateDiagnosis：(1)Viralpneumonia(CMVEBV)(2)PCP(3)Chlamydiapneumonia4成年人病毒性肺炎流感病毒、麻疹病毒、漢坦病毒、腺病毒、單純皰疹病毒、水痘帶狀皰疹病毒、巨細(xì)胞病毒以及EB病毒等多種病毒能夠引起成年人下呼吸道感染。成年人病毒性肺炎可分為兩種類型：發(fā)生于健康宿主的非典型性肺炎；發(fā)生于免疫缺陷宿主的病毒性肺炎。5免疫正常

4、及免疫缺陷患者常見(jiàn)的病毒感染免疫正?；颊吡鞲胁《緷h坦病毒EB病毒腺病毒免疫缺陷患者單純皰疹病毒水痘帶狀皰疹病毒巨細(xì)胞病毒麻疹病毒腺病毒6成年人病毒性肺炎影像學(xué)表現(xiàn)多種多樣且相互重疊?；颊吣挲g、免疫狀況、社區(qū)性爆發(fā)、起病狀況、嚴(yán)重程度及持續(xù)時(shí)間、有無(wú)發(fā)疹等臨床信息對(duì)于診斷具有重要幫助。實(shí)驗(yàn)室檢查7常見(jiàn)的病理學(xué)表現(xiàn)病毒能夠引起：氣管支氣管炎，細(xì)支氣管炎，肺炎。上皮細(xì)胞及相鄰間質(zhì)組織學(xué)改變最為顯著。8常見(jiàn)的病理學(xué)表現(xiàn)氣管支氣管炎：氣道壁充血，

5、管腔內(nèi)單核細(xì)胞浸潤(rùn)，上皮細(xì)胞變性、脫落。細(xì)支氣管炎：兒童常見(jiàn)，上皮細(xì)胞壞死，管腔內(nèi)嗜中性粒細(xì)胞滲出，氣道壁內(nèi)單核細(xì)胞為主的炎性細(xì)胞浸潤(rùn)。9常見(jiàn)的病理學(xué)表現(xiàn)實(shí)質(zhì)受累（肺炎）：終末及呼吸性細(xì)支氣管相鄰肺組織首先受累，可進(jìn)展至整個(gè)肺葉。老年及免疫缺陷患者可發(fā)生快速進(jìn)展的肺炎。組織學(xué)上，雙肺彌漫性肺泡破壞（間質(zhì)淋巴細(xì)胞浸潤(rùn)，氣腔內(nèi)出血，水腫及纖維蛋白滲出，2型肺泡上皮增生，透明膜形成）10Photomicrograph(iginalmagnif

6、ication100hematoxylineosinstain)ofalungbiopsyspecimenfroma36yearoldmanwithpneumoniaduetoherpessimplexvirustype1showsafibrousexudate(largearrows)alongthealveolarwalls.Notetheinterstitialthickeningduetofibroblasticprolifer

7、ation(smallarrows).11常見(jiàn)的影像學(xué)表現(xiàn)氣管支氣管炎：急性期很少出現(xiàn)異常影像學(xué)改變，但多年后粘膜破壞可表現(xiàn)為支氣管擴(kuò)張。細(xì)支氣管炎：氣道阻塞常為不完全性，影像學(xué)上表現(xiàn)為過(guò)度通氣及邊界不清的結(jié)節(jié)灶。12常見(jiàn)的影像學(xué)表現(xiàn)病毒性肺炎：邊界不清的結(jié)節(jié)（410mm的氣腔內(nèi)結(jié)節(jié)）。細(xì)支氣管周圍斑片狀磨玻璃密度及氣腔實(shí)變。常伴有過(guò)度通氣?？焖龠M(jìn)展型肺炎：實(shí)變區(qū)快速融合，引起彌漫性肺泡損害（均一性或斑片狀單側(cè)或雙側(cè)氣腔內(nèi)實(shí)變，以及磨玻

8、璃密度灶或界限不清的小葉核心結(jié)節(jié)）。13Photomicrograph(iginalmagnification100hematoxylineosinstain)ofalungbiopsyspecimenfroma36yearoldmanwithpneumoniaduetoherpessimplexvirustype1showsafibrousexudate(largearrows)alongthealveolarwalls.Noteth

9、einterstitialthickeningduetofibroblasticproliferation(smallarrows).Photomicrograph(iginalmagnification100hematoxylineosinstain)ofalungbiopsyspecimenfroma36yearoldmanwithpneumoniaduetoherpessimplexvirustype1showsafibrouse

10、xudate(largearrows)alongthealveolarwalls.Notetheinterstitialthickeningduetofibroblasticproliferation(smallarrows).Photomicrograph(iginalmagnification100hematoxylineosinstain)ofalungbiopsyspecimenfroma36yearoldmanwithpneu

11、moniaduetoherpessimplexvirustype1showsafibrousexudate(largearrows)alongthealveolarwalls.Notetheinterstitialthickeningduetofibroblasticproliferation(smallarrows).Pneumoniaduetoinfluenzavirus(typeC)ina46yearoldmanwithdyspn

12、ea.Initialchestradiographshowsdiffusereticulonodularareasofincreasedopacityinbothlungs.14Pneumoniaduetoinfluenzavirus(typeC)ina46yearoldmanwithdyspnea.Followupchestradiographobtained15dayslatershowsprogressionoftheextent

13、ofdiseasewithdiffuseconsolidationthroughoutbothlungs.Pneumoniaduetoinfluenzavirus(typeC)ina46yearoldmanwithdyspnea.(a)Initialchestradiographshowsdiffusereticulonodularareasofincreasedopacityinbothlungs.(b)Followupchestra

14、diographobtained15daysafterashowsprogressionoftheextentofdiseasewithdiffuseconsolidationthroughoutbothlungs.(c)Thinsection(1mmcollimation)computedtomographic(CT)scanobtained16daysafteraattheleveloftheaticarchshowsdiffuse

15、groundglassattenuationwithsomeirregularlinearareasofincreasedattenuationinbothlungs.(CasecourtesyofDrJungHwaHwangSoonchunhyangUniversitySeoulHospitalKea.)Pneumoniaduetoinfluenzavirus(typeC)ina46yearoldmanwithdyspnea.(a)I

16、nitialchestradiographshowsdiffusereticulonodularareasofincreasedopacityinbothlungs.(b)Followupchestradiographobtained15daysafterashowsprogressionoftheextentofdiseasewithdiffuseconsolidationthroughoutbothlungs.(c)Thinsect

17、ion(1mmcollimation)computedtomographic(CT)scanobtained16daysafteraattheleveloftheaticarchshowsdiffusegroundglassattenuationwithsomeirregularlinearareasofincreasedattenuationinbothlungs.(CasecourtesyofDrJungHwaHwangSoonch

18、unhyangUniversitySeoulHospitalKea.)Pneumoniaduetoinfluenzavirus(typeC)ina46yearoldmanwithdyspnea.(a)Initialchestradiographshowsdiffusereticulonodularareasofincreasedopacityinbothlungs.(b)Followupchestradiographobtained15

19、daysafterashowsprogressionoftheextentofdiseasewithdiffuseconsolidationthroughoutbothlungs.(c)Thinsection(1mmcollimation)computedtomographic(CT)scanobtained16daysafteraattheleveloftheaticarchshowsdiffusegroundglassattenua

20、tionwithsomeirregularlinearareasofincreasedattenuationinbothlungs.(CasecourtesyofDrJungHwaHwangSoonchunhyangUniversitySeoulHospitalKea.)15Pneumoniaduetoinfluenzavirus(typeC)ina46yearoldmanwithdyspnea.Thinsection(1mmcolli

21、mation)computedtomographic(CT)scanobtained1dayafterthesecondchestradiographattheleveloftheaticarchshowsdiffusegroundglassattenuationwithsomeirregularlinearareasofincreasedattenuationinbothlungs.16成年人巨細(xì)胞病毒性肺炎巨細(xì)胞病毒：DNA病毒皰疹

22、病毒的一種免疫缺陷患者嚴(yán)重癥狀的肺炎。17成年人巨細(xì)胞病毒性肺炎18成年人巨細(xì)胞病毒性肺炎常見(jiàn)CT表現(xiàn)：磨玻璃密度影實(shí)變結(jié)節(jié)灶邊界不清的小葉核心結(jié)節(jié)支氣管擴(kuò)張小葉間隔增厚19成年人巨細(xì)胞病毒性肺炎Kangetal報(bào)告了10例患巨細(xì)胞病毒性肺炎移植受體的CT表現(xiàn)：結(jié)節(jié)(n=6)實(shí)變(n=4)(n=4)不規(guī)則線狀影(n=1)。KimLee報(bào)告了11例免疫缺陷患者的高分辨CT表現(xiàn)磨玻璃密度影(n=11)不規(guī)則線狀影(n=10)實(shí)變(n=7)多

23、發(fā)小結(jié)節(jié)或腫塊(n=6)支氣管擴(kuò)張或小葉間隔增厚(n=5)。20Pneumoniaduetocytomegalovirusina28yearoldmanwithacutemyeloidleukemia.Thinsection(1mmcollimation)CTscanobtainedatthelevelofthebronchusintermediusshowsmultifocalpatchygroundglassattenuationp

24、olydefinedcentrilobularnodules(arrows)inbothlungs.21Pneumoniaduetocytomegalovirusina28yearoldmanwithacutemyeloidleukemia.Photomicrograph(iginalmagnification40hematoxylineosinstain)showsdiffuseinterstitialintraalveolarfib

25、roblasticproliferation(arrows)withsomemononuclearcellinfiltration(diffusealveolardamageganizingstage).22TitlePneumoniaduetocytomegalovirusina28yearoldmanwithacutemyeloidleukemia.(1)Photomicrograph(iginalmagnification400h

26、ematoxylineosinstain)showsthreelargenucleicontainingeosinophilicinclusionbodies(arrows)withinhyperplasticpneumocytes.(2)Photomicrograph(iginalmagnification400immunohistochemicalmarkerfcytomegalovirus)showspositiveintranu

27、clearinclusionbodies(arrows).23TitlePneumoniaduetocytomegalovirusina45yearoldmanwhounderwentlivertransplantation.Chestradiographobtained4weeksafterlivertransplantationshowspatchyairspaceconsolidationinbothlungs.Anendotra

28、chealintubationtubeapigtaildrainagecatheterintherightpleuralspaceachesttubeintheleftpleuralspaceacentralvenouscatheterareseen.24TitlePneumoniaduetocytomegalovirusina45yearoldmanwhounderwentlivertransplantation.Thinsectio

29、n(1mmcollimation)CTscanobtainedattheleveloftherightupperlobebronchus2daysbefetheChestradiographshowsmultifocalpatchygroundglassattenuationinbothlungs.Notetheconsolidation(whitearrow)thesmallpolydefinednodules(blackarrows