成年人巨細(xì)胞病毒性肺炎

——影像學(xué)及病理學(xué)表現(xiàn)整理課件1成年人巨細(xì)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(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(lèi)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(jiàn)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(xì)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(jiàn)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(xué)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(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)室檢查整理課件7成年人病毒性肺炎影像學(xué)表現(xiàn)多種多樣且相互重疊。整理課件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。整理課件8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，肺炎常見(jiàn)的病理學(xué)表現(xiàn)氣管支氣管炎：氣道壁充血，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)。整理課件9常見(jiàn)的病理學(xué)表現(xiàn)氣管支氣管炎：氣道壁充血，管腔內(nèi)單核細(xì)胞浸潤(rùn)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）整理課件10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

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

Photomicrograph(origina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。

整理課件12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，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)（4-10mm的氣腔內(nèi)結(jié)節(jié)）。細(xì)支氣管周?chē)咂瑺钅ゲＡ芏燃皻馇粚?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(jiàn)的影像學(xué)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(xì)胞病毒性肺炎巨細(xì)胞病毒：DNA病毒皰疹病毒的一種免疫缺陷患者嚴(yán)重癥狀的肺炎。整理課件17成年人巨細(xì)胞病毒性肺炎巨細(xì)胞病毒：整理課件17成年人巨細(xì)胞病毒性肺炎致病機(jī)制組織病理學(xué)特點(diǎn)同種異體移植受體T細(xì)胞介導(dǎo)抗原-抗體反應(yīng)。即使抑制病毒復(fù)制時(shí)也可發(fā)生嚴(yán)重的壞死性肺炎。壞死性炎癥顯著感染巨細(xì)胞病毒的細(xì)胞相對(duì)較少AIDS患者免疫缺陷更嚴(yán)重巨細(xì)胞病毒的細(xì)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(jiàn)。大量巨細(xì)胞病毒包涵體。整理課件18成年人巨細(xì)胞病毒性肺炎致病機(jī)制組織病理學(xué)特點(diǎn)同種異體移植受體成年人巨細(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)張小葉間隔增厚整理課件19成年人巨細(xì)胞病毒性肺炎常見(jiàn)CT表現(xiàn)：整理課件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)。KimandLee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)。整理課件20成年人巨細(xì)胞病毒性肺炎Kangetal報(bào)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(xué)表現(xiàn)多種多樣且相互重疊，巨細(xì)胞病毒性感染時(shí)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(xué)特點(diǎn)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(xué)表現(xiàn)多種多樣且相互重疊，巨細(xì)胞病毒感謝聆聽(tīng)！整理課件27感謝聆聽(tīng)！整理課件27成年人巨細(xì)胞病毒性肺炎

——影像學(xué)及病理學(xué)表現(xiàn)整理課件28成年人巨細(xì)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(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(lèi)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(jiàn)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(xì)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(jiàn)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(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)室檢查整理課件34成年人病毒性肺炎影像學(xué)表現(xiàn)多種多樣且相互重疊。整理課件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。整理課件35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，肺炎常見(jiàn)的病理學(xué)表現(xiàn)氣管支氣管炎：氣道壁充血，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)。整理課件36常見(jiàn)的病理學(xué)表現(xiàn)氣管支氣管炎：氣道壁充血，管腔內(nèi)單核細(xì)胞浸潤(rùn)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）整理課件37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

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

Photomicrograph(origina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。

整理課件39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，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)（4-10mm的氣腔內(nèi)結(jié)節(jié)）。細(xì)支氣管周?chē)咂瑺钅ゲＡ芏燃皻馇粚?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(jiàn)的影像學(xué)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(xì)胞病毒性肺炎巨細(xì)胞病毒：DNA病毒皰疹病毒的一種免疫缺陷患者嚴(yán)重癥狀的肺炎。整理課件44成年人巨細(xì)胞病毒性肺炎巨細(xì)胞病毒：整理課件17成年人巨細(xì)胞病毒性肺炎致病機(jī)制組織病理學(xué)特點(diǎn)同種異體移植受體T細(xì)胞介導(dǎo)抗原-抗體反應(yīng)。即使抑制病毒復(fù)制時(shí)也可發(fā)生嚴(yán)重的壞死性肺炎。壞死性炎癥顯著感染巨細(xì)胞病毒的細(xì)胞相對(duì)較少AIDS患者免疫缺陷更嚴(yán)重巨細(xì)胞病毒的細(xì)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(jiàn)。大量巨細(xì)胞病毒包涵體。整理課件45成年人巨細(xì)胞病毒性肺炎致病機(jī)制組織病理學(xué)特點(diǎn)同種異體移植受體成年人巨細(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)張小葉間隔增厚整理課件46成年人巨細(xì)胞病毒性肺炎常見(jiàn)CT表現(xiàn)：整理課件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)。KimandLee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)。整理課件47成年人巨細(xì)胞病毒性肺炎Kangetal報(bào)告了10例患巨Pneumoniaduetocytomegalovirusina28-year-oldmanwithacutemyeloidleukemia.Thin-section(1-mmcollimation)CTscanobtainedatthelevelofthebronchusintermediusshowsmultifocalpatchyground-glassattenuationandpoorlydefinedcentrilobularnodules(arrows)inbothlungs.整理課件48PneumoniaduetocytomegalovirPneumoniaduetocytomegalovirusina28-year-oldmanwithacutemye