成年人巨細胞病毒性肺炎ppt課件

1、成年人巨細胞病毒性肺炎——影像學及病理學表現(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胞病毒麻疹病毒腺病毒6成年人病毒性肺炎影像學表現(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、嚴重程度及持續(xù)時間、有無發(fā)疹等臨床信息對于診斷具有重要幫助。實驗室檢查7常見的病理學表現(xiàn)病毒能夠引起：氣管支氣管炎，細支氣管炎，肺炎。上皮細胞及相鄰間質(zhì)組織學改變最為顯著。8常見的病理學表現(xiàn)氣管支氣管炎：氣道壁充血，

5、管腔內(nèi)單核細胞浸潤，上皮細胞變性、脫落。細支氣管炎：兒童常見，上皮細胞壞死，管腔內(nèi)嗜中性粒細胞滲出，氣道壁內(nèi)單核細胞為主的炎性細胞浸潤。9常見的病理學表現(xiàn)實質(zhì)受累（肺炎）：終末及呼吸性細支氣管相鄰肺組織首先受累，可進展至整個肺葉。老年及免疫缺陷患者可發(fā)生快速進展的肺炎。組織學上，雙肺彌漫性肺泡破壞（間質(zhì)淋巴細胞浸潤，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常見的影像學表現(xiàn)氣管支氣管炎：急性期很少出現(xiàn)異常影像學改變，但多年后粘膜破壞可表現(xiàn)為支氣管擴張。細支氣管炎：氣道阻塞常為不完全性，影像學上表現(xiàn)為過度通氣及邊界不清的結節(jié)灶。12常見的影像學表現(xiàn)病毒性肺炎：邊界不清的結節(jié)（410mm的氣腔內(nèi)結節(jié)）。細支氣管周圍斑片狀磨玻璃密度及氣腔實變。常伴有過度通氣?？焖龠M展型肺炎：實變區(qū)快速融合，引起彌漫性肺泡損害（均一性或斑片狀單側或雙側氣腔內(nèi)實變，以及磨玻

8、璃密度灶或界限不清的小葉核心結節(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成年人巨細胞病毒性肺炎巨細胞病毒：DNA病毒皰疹

22、病毒的一種免疫缺陷患者嚴重癥狀的肺炎。17成年人巨細胞病毒性肺炎18成年人巨細胞病毒性肺炎常見CT表現(xiàn)：磨玻璃密度影實變結節(jié)灶邊界不清的小葉核心結節(jié)支氣管擴張小葉間隔增厚19成年人巨細胞病毒性肺炎Kangetal報告了10例患巨細胞病毒性肺炎移植受體的CT表現(xiàn)：結節(jié)(n=6)實變(n=4)(n=4)不規(guī)則線狀影(n=1)。KimLee報告了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)實變(n=7)多

23、發(fā)小結節(jié)或腫塊(n=6)支氣管擴張或小葉間隔增厚(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