成年人巨細胞病毒性肺炎課件

成年人巨細胞病毒性肺炎

——影像學及病理學表現(xiàn)整理課件1成年人巨細胞病毒性肺炎

CaseName：MePingSex：FemaleAge：46PNo.：P10044471

整理課件2CaseName：MePing整理課件2CaseExamineDate2009-08-17Thin-section(1-mmcollimation)computedtomographic(CT)scanshowsBilateraldiffuseground-glassattenuationwiththickenedinterlobularsepta,andAlobulardistribution,segmentalconsolidationwiththe“inflatedbronchia”sign.Thereareseverallymphnodesinthemediastina.Nopleuraleffusion.Theheart,liver,spleenandotherscannedareasarenormal.

整理課件3CaseExamineDate2009-08-17CaseDiagnosis:Bilateraldiffuselesionoflung,consideredasinfection.DifferentiateDiagnosis：(1)Viralpneumonia(CMV,EBV)(2)PCP(3)Chlamydiapneumonia

整理課件4CaseDiagnosis:Bilateraldiffu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。整理課件5成年人病毒性肺炎流感病毒、麻疹病毒、漢坦病毒、腺病毒、單純免疫正常及免疫缺陷患者常見的病毒感染免疫正常患者

流感病毒漢坦病毒

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

整理課件6免疫正常及免疫缺陷患者常見的病毒感染免疫正?；颊呙庖呷毕莼颊叱赡耆瞬《拘苑窝子跋駥W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。實驗室檢查整理課件7成年人病毒性肺炎影像學表現(xiàn)多種多樣且相互重疊。整理課件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。整理課件8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，肺炎常見的病理學表現(xiàn)氣管支氣管炎：氣道壁充血，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。整理課件9常見的病理學表現(xiàn)氣管支氣管炎：氣道壁充血，管腔內(nèi)單核細胞浸潤常見的病理學表現(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）整理課件10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

Photomicrograph(originalmagnification,×100;hematoxylin-eosinstain)ofalungbiopsyspecimenfroma36-year-oldmanwithpneumoniaduetoherpessimplexvirustype1showsafibrousexudate(largearrows)alongthealveolarwalls.Notetheinterstitialthickeningduetofibroblasticproliferation(smallarrows).整理課件11

Photomicrograph(origina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(jié)節(jié)灶。

整理課件12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，常見的影像學表現(xiàn)病毒性肺炎：邊界不清的結(jié)節(jié)（4-10mm的氣腔內(nèi)結(jié)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(cè)或雙側(cè)氣腔內(nèi)實變，以及磨玻璃密度灶或界限不清的小葉核心結(jié)節(jié)）。整理課件13常見的影像學表現(xiàn)病毒性肺炎：整理課件13Photomicrograph(originalmagnification,×100;hematoxylin-eosinstain)ofalungbiopsyspecimenfroma36-year-oldmanwithpneumoniaduetoherpessimplexvirustype1showsafibrousexudate(largearrows)alongthealveolarwalls.Notetheinterstitialthickeningduetofibroblasticproliferation(smallarrows).Photomicrograph(originalmagnification,×100;hematoxylin-eosinstain)ofalungbiopsyspecimenfroma36-year-oldmanwithpneumoniaduetoherpessimplexvirustype1showsafibrousexudate(largearrows)alongthealveolarwalls.Notetheinterstitialthickeningduetofibroblasticproliferation(smallarrows).Photomicrograph(originalmagnification,×100;hematoxylin-eosinstain)ofalungbiopsyspecimenfroma36-year-oldmanwithpneumoniaduetoherpessimplexvirustype1showsafibrousexudate(largearrows)alongthealveolarwalls.Notetheinterstitialthickeningduetofibroblasticproliferation(smallarrows).

Pneumoniaduetoinfluenzavirus(typeC)ina46-year-oldmanwithdyspnea.Initialchestradiographshowsdiffusereticulonodularareasofincreasedopacityinbothlungs.整理課件14Photomicrograph(originalmagn

Pneumoniaduetoinfluenzavirus(typeC)ina46-year-oldmanwithdyspnea.Follow-upchestradiographobtained15dayslatershowsprogressionoftheextentofdiseasewithdiffuseconsolidationthroughoutbothlungs.

Pneumoniaduetoinfluenzavirus(typeC)ina46-year-oldmanwithdyspnea.(a)Initialchestradiographshowsdiffusereticulonodularareasofincreasedopacityinbothlungs.(b)Follow-upchestradiographobtained15daysafterashowsprogressionoftheextentofdiseasewithdiffuseconsolidationthroughoutbothlungs.(c)Thin-section(1-mmcollimation)computedtomographic(CT)scanobtained16daysafteraattheleveloftheaorticarchshowsdiffuseground-glassattenuationwithsomeirregularlinearareasofincreasedattenuationinbothlungs.(CasecourtesyofDrJungHwaHwang,SoonchunhyangUniversitySeoulHospital,Korea.)

Pneumoniaduetoinfluenzavirus(typeC)ina46-year-oldmanwithdyspnea.(a)Initialchestradiographshowsdiffusereticulonodularareasofincreasedopacityinbothlungs.(b)Follow-upchestradiographobtained15daysafterashowsprogressionoftheextentofdiseasewithdiffuseconsolidationthroughoutbothlungs.(c)Thin-section(1-mmcollimation)computedtomographic(CT)scanobtained16daysafteraattheleveloftheaorticarchshowsdiffuseground-glassattenuationwithsomeirregularlinearareasofincreasedattenuationinbothlungs.(CasecourtesyofDrJungHwaHwang,SoonchunhyangUniversitySeoulHospital,Korea.)

Pneumoniaduetoinfluenzavirus(typeC)ina46-year-oldmanwithdyspnea.(a)Initialchestradiographshowsdiffusereticulonodularareasofincreasedopacityinbothlungs.(b)Follow-upchestradiographobtained15daysafterashowsprogressionoftheextentofdiseasewithdiffuseconsolidationthroughoutbothlungs.(c)Thin-section(1-mmcollimation)computedtomographic(CT)scanobtained16daysafteraattheleveloftheaorticarchshowsdiffuseground-glassattenuationwithsomeirregularlinearareasofincreasedattenuationinbothlungs.(CasecourtesyofDrJungHwaHwang,SoonchunhyangUniversitySeoulHospital,Korea.)整理課件15

Pneumoniaduetoinfluenza

Pneumoniaduetoinfluenzavirus(typeC)ina46-year-oldmanwithdyspnea.Thin-section(1-mmcollimation)computedtomographic(CT)scanobtained1dayafterthesecondchestradiographattheleveloftheaorticarchshowsdiffuseground-glassattenuationwithsomeirregularlinearareasofincreasedattenuationinbothlungs.整理課件16

Pneumoniaduetoinfluen成年人巨細胞病毒性肺炎巨細胞病毒：DNA病毒皰疹病毒的一種免疫缺陷患者嚴重癥狀的肺炎。整理課件17成年人巨細胞病毒性肺炎巨細胞病毒：整理課件17成年人巨細胞病毒性肺炎致病機制組織病理學特點同種異體移植受體T細胞介導(dǎo)抗原-抗體反應(yīng)。即使抑制病毒復(fù)制時也可發(fā)生嚴重的壞死性肺炎。壞死性炎癥顯著感染巨細胞病毒的細胞相對較少AIDS患者免疫缺陷更嚴重巨細胞病毒的細胞致病作用引起肺損害。彌漫肺泡損害常較不患有AIDS的患者常見。大量巨細胞病毒包涵體。整理課件18成年人巨細胞病毒性肺炎致病機制組織病理學特點同種異體移植受體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(jié)節(jié)灶邊界不清的小葉核心結(jié)節(jié)支氣管擴張小葉間隔增厚整理課件19成年人巨細胞病毒性肺炎常見CT表現(xiàn)：整理課件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(jié)節(jié)(n=6),實變(n=4),(n=4),不規(guī)則線狀影

(n=1)。KimandLee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),多發(fā)小結(jié)節(jié)或腫塊(n=6),支氣管擴張或小葉間隔增厚(n=5)。整理課件20成年人巨細胞病毒性肺炎Kangetal報告了10例患巨Pneumoniaduetocytomegalovirusina28-year-oldmanwithacutemyeloidleukemia.Thin-section(1-mmcollimation)CTscanobtainedatthelevelofthebronchusintermediusshowsmultifocalpatchyground-glassattenuationandpoorlydefinedcentrilobularnodules(arrows)inbothlungs.整理課件21PneumoniaduetocytomegalovirPneumoniaduetocytomegalovirusina28-year-oldmanwithacutemyeloidleukemia.Photomicrograph(originalmagnification,×40;hematoxylin-eosinstain)showsdiffuseinterstitialandintraalveolarfibroblasticproliferation(arrows)withsomemononuclearcellinfiltration(diffusealveolardamage,organizingstage).整理課件22PneumoniaduetocytomegalovirTitle

Pneumoniaduetocytomegalovirusina28-year-oldmanwithacutemyeloidleukemia.(1)Photomicrograph(originalmagnification,×400;hematoxylin-eosinstain)showsthreelargenucleicontainingeosinophilicinclusionbodies(arrows)withinhyperplasticpneumocytes.(2)Photomicrograph(originalmagnification,×400;immunohistochemicalmarkerforcytomegalovirus)showspositiveintranuclearinclusionbodies(arrows).整理課件23TitlePneumoniaduetocytTitlePneumoniaduetocytomegalovirusina45-year-oldmanwhounderwentlivertransplantation.Chestradiographobtained4weeksafterlivertransplantationshowspatchyair-spaceconsolidationinbothlungs.Anendotrachealintubationtube,apigtaildrainagecatheterintherightpleuralspace,achesttubeintheleftpleuralspace,andacentralvenouscatheterareseen.整理課件24TitlePneumoniaduetocyTitlePneumoniaduetocytomegalovirusina45-year-oldmanwhounderwentlivertransplantation.Thin-section(1-mmcollimation)CTscanobtainedattheleveloftherightupperlobebronchus2daysbeforetheChestradiographshowsmultifocalpatchyground-glassattenuationinbothlungs.Notetheconsolidation(whitearrow)andthesmall,poorlydefinednodules(blackarrows).Thereareassociatedbilateralpleuraleffusions.整理課件25TitlePneumoniaduetocy

成年人病毒性肺炎的影像學表現(xiàn)多種多樣且相互重疊，巨細胞病毒性感染時可伴有其它病毒及不典型致病菌的感染，不能僅依靠影像學特點做出病毒性肺炎特定微生物的診斷。

總結(jié)整理課件26

成年人病毒性肺炎的影像學表現(xiàn)多種多樣且相互重疊，巨細胞病毒感謝聆聽！整理課件27感謝聆聽！整理課件27成年人巨細胞病毒性肺炎

——影像學及病理學表現(xiàn)整理課件28成年人巨細胞病毒性肺炎

CaseName：MePingSex：FemaleAge：46PNo.：P10044471

整理課件29CaseName：MePing整理課件2CaseExamineDate2009-08-17Thin-section(1-mmcollimation)computedtomographic(CT)scanshowsBilateraldiffuseground-glassattenuationwiththickenedinterlobularsepta,andAlobulardistribution,segmentalconsolidationwiththe“inflatedbronchia”sign.Thereareseverallymphnodesinthemediastina.Nopleuraleffusion.Theheart,liver,spleenandotherscannedareasarenormal.

整理課件30CaseExamineDate2009-08-17CaseDiagnosis:Bilateraldiffuselesionoflung,consideredasinfection.DifferentiateDiagnosis：(1)Viralpneumonia(CMV,EBV)(2)PCP(3)Chlamydiapneumonia

整理課件31CaseDiagnosis:Bilateraldiffu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。整理課件32成年人病毒性肺炎流感病毒、麻疹病毒、漢坦病毒、腺病毒、單純免疫正常及免疫缺陷患者常見的病毒感染免疫正常患者

流感病毒漢坦病毒

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

整理課件33免疫正常及免疫缺陷患者常見的病毒感染免疫正?；颊呙庖呷毕莼颊叱赡耆瞬《拘苑窝子跋駥W表現(xiàn)多種多樣且相互重疊。患者年齡、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。實驗室檢查整理課件34成年人病毒性肺炎影像學表現(xiàn)多種多樣且相互重疊。整理課件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。整理課件35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，肺炎常見的病理學表現(xiàn)氣管支氣管炎：氣道壁充血，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。整理課件36常見的病理學表現(xiàn)氣管支氣管炎：氣道壁充血，管腔內(nèi)單核細胞浸潤常見的病理學表現(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）整理課件37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

Photomicrograph(originalmagnification,×100;hematoxylin-eosinstain)ofalungbiopsyspecimenfroma36-year-oldmanwithpneumoniaduetoherpessimplexvirustype1showsafibrousexudate(largearrows)alongthealveolarwalls.Notetheinterstitialthickeningduetofibroblasticproliferation(smallarrows).整理課件38

Photomicrograph(origina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(jié)節(jié)灶。

整理課件39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，常見的影像學表現(xiàn)病毒性肺炎：邊界不清的結(jié)節(jié)（4-10mm的氣腔內(nèi)結(jié)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(cè)或雙側(cè)氣腔內(nèi)實變，以及磨玻璃密度灶或界限不清的小葉核心結(jié)節(jié)）。整理課件40常見的影像學表現(xiàn)病毒性肺炎：整理課件13Photomicrograph(originalmagnification,×100;hematoxylin-eosinstain)ofalungbiopsyspecimenfroma36-year-oldmanwithpneumoniaduetoherpessimplexvirustype1showsafibrousexudate(largearrows)alongthealveolarwalls.Notetheinterstitialthickeningduetofibroblasticproliferation(smallarrows).Photomicrograph(originalmagnification,×100;hematoxylin-eosinstain)ofalungbiopsyspecimenfroma36-year-oldmanwithpneumoniaduetoherpessimplexvirustype1showsafibrousexudate(largearrows)alongthealveolarwalls.Notetheinterstitialthickeningduetofibroblasticproliferation(smallarrows).Photomicrograph(originalmagnification,×100;hematoxylin-eosinstain)ofalungbiopsyspecimenfroma36-year-oldmanwithpneumoniaduetoherpessimplexvirustype1showsafibrousexudate(largearrows)alongthealveolarwalls.Notetheinterstitialthickeningduetofibroblasticproliferation(smallarrows).

Pneumoniaduetoinfluenzavirus(typeC)ina46-year-oldmanwithdyspnea.Initialchestradiographshowsdiffusereticulonodularareasofincreasedopacityinbothlungs.整理課件41Photomicrograph(originalmagn

Pneumoniaduetoinfluenzavirus(typeC)ina46-year-oldmanwithdyspnea.Follow-upchestradiographobtained15dayslatershowsprogressionoftheextentofdiseasewithdiffuseconsolidationthroughoutbothlungs.

Pneumoniaduetoinfluenzavirus(typeC)ina46-year-oldmanwithdyspnea.(a)Initialchestradiographshowsdiffusereticulonodularareasofincreasedopacityinbothlungs.(b)Follow-upchestradiographobtained15daysafterashowsprogressionoftheextentofdiseasewithdiffuseconsolidationthroughoutbothlungs.(c)Thin-section(1-mmcollimation)computedtomographic(CT)scanobtained16daysafteraattheleveloftheaorticarchshowsdiffuseground-glassattenuationwithsomeirregularlinearareasofincreasedattenuationinbothlungs.(CasecourtesyofDrJungHwaHwang,SoonchunhyangUniversitySeoulHospital,Korea.)

Pneumoniaduetoinfluenzavirus(typeC)ina46-year-oldmanwithdyspnea.(a)Initialchestradiographshowsdiffusereticulonodularareasofincreasedopacityinbothlungs.(b)Follow-upchestradiographobtained15daysafterashowsprogressionoftheextentofdiseasewithdiffuseconsolidationthroughoutbothlungs.(c)Thin-section(1-mmcollimation)computedtomographic(CT)scanobtained16daysafteraattheleveloftheaorticarchshowsdiffuseground-glassattenuationwithsomeirregularlinearareasofincreasedattenuationinbothlungs.(CasecourtesyofDrJungHwaHwang,SoonchunhyangUniversitySeoulHospital,Korea.)

Pneumoniaduetoinfluenzavirus(typeC)ina46-year-oldmanwithdyspnea.(a)Initialchestradiographshowsdiffusereticulonodularareasofincreasedopacityinbothlungs.(b)Follow-upchestradiographobtained15daysafterashowsprogressionoftheextentofdiseasewithdiffuseconsolidationthroughoutbothlungs.(c)Thin-section(1-mmcollimation)computedtomographic(CT)scanobtained16daysafteraattheleveloftheaorticarchshowsdiffuseground-glassattenuationwithsomeirregularlinearareasofincreasedattenuationinbothlungs.(CasecourtesyofDrJungHwaHwang,SoonchunhyangUniversitySeoulHospital,Korea.)整理課件42

Pneumoniaduetoinfluenza

Pneumoniaduetoinfluenzavirus(typeC)ina46-year-oldmanwithdyspnea.Thin-section(1-mmcollimation)computedtomographic(CT)scanobtained1dayafterthesecondchestradiographattheleveloftheaorticarchshowsdiffuseground-glassattenuationwithsomeirregularlinearareasofincreasedattenuationinbothlungs.整理課件43

Pneumoniaduetoinfluen成年人巨細胞病毒性肺炎巨細胞病毒：DNA病毒皰疹病毒的一種免疫缺陷患者嚴重癥狀的肺炎。整理課件44成年人巨細胞病毒性肺炎巨細胞病毒：整理課件17成年人巨細胞病毒性肺炎致病機制組織病理學特點同種異體移植受體T細胞介導(dǎo)抗原-抗體反應(yīng)。即使抑制病毒復(fù)制時也可發(fā)生嚴重的壞死性肺炎。壞死性炎癥顯著感染巨細胞病毒的細胞相對較少AIDS患者免疫缺陷更嚴重巨細胞病毒的細胞致病作用引起肺損害。彌漫肺泡損害常較不患有AIDS的患者常見。大量巨細胞病毒包涵體。整理課件45成年人巨細胞病毒性肺炎致病機制組織病理學特點同種異體移植受體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(jié)節(jié)灶邊界不清的小葉核心結(jié)節(jié)支氣管擴張小葉間隔增厚整理課件46成年人巨細胞病毒性肺炎常見CT表現(xiàn)：整理課件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(jié)節(jié)(n=6),實變(n=4),(n=4),不規(guī)則線狀影

(n=1)。KimandLee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),多發(fā)小結(jié)節(jié)或腫塊(n=6),支氣管擴張或小葉間隔增厚(n=5)。整理課件47成年人巨細胞病毒性肺炎Kangetal報告了10例患巨Pneumoniaduetocytomegalovirusina28-year-oldmanwithacutemyeloidleukemia.Thin-section(1-mmcollimation)CTscanobtainedatthelevelofthebronchusintermediusshowsmultifocalpatchyground-glassattenuationandpoorlydefinedcentrilobularnodules(arrows)inbothlungs.整理課件48PneumoniaduetocytomegalovirPneumoniaduetocytomegalovirusina28-year-oldmanwithacutemye