30例卫氏并殖吸虫病患者临床及影像学特征
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摘要
目的分析卫氏并殖吸虫病肺内及肺外临床表现及影像学特征。方法收集经实验室和临床确诊的30例卫氏并殖吸虫感染病例资料,回顾性分析卫氏并殖吸虫病患者临床及影像学特征。结果卫氏并殖吸虫病患者肺内症状以胸闷、发热、胸痛、咳嗽、咳痰、呼吸困难为主,肺外表现有腹痛、呕吐、腹泻、纳差、消瘦、双下肢乏力、头痛、头昏、癫痫样发作、皮下游走性包块等。30例卫氏并殖吸虫病患者血清或胸腔积液嗜酸性粒细胞计数增加。患者胸部CT异常主要有结节、磨玻璃样变、虫蚀样变、胸腔积液、"隧道"征、"月晕"征等,头颅CT和MRI可见颅内出血灶及大范围"指套样"水肿,腹部CT呈肝脾包膜下蛇纹石样变、"隧道"征样变。结论卫氏并殖吸虫病以多器官系统受累为特征;CT及MRI示"隧道"征、蛇纹石样变系由卫氏并殖吸虫在颅内、肺内、肝脾内迁移游走形成,是本病的重要影像学征象。
Objective To analyze the clinical manifestations and imaging characteristics of pulmonary and extra pulmonary paragonimiasis westermani. Methods A retrospective analysis was performed of 30 patients diagnosed by clinical features, laboratory serological tests and surgical pathology. Results The symptoms of the lung included mainly chest distress, fever, chest pain, cough and expectoration, and dyspnea. The extra pulmonary symptoms included abdominal pain, vomiting, diarrhea, poor appetite, emaciation, both lower extremities asthenia, headache, dizziness, epileptic seizures, and subcutaneous migratory masses. The laboratory examination showed that the eosinophil numbers of serum and pleural effusion of all the thirty patients were increased, and the eggs of Paragonimus westermani were found by the stool tests in four cases. The chest CT tests found abnormal nodules, ground glass changes, insect damages, pleural effusion, "tunnel" signs, and "halo" signs. Cranial CT and MRI showed intracranial hemorrhage foci, and extensive "finger-like" edema. Abdominal CT showed serpentine deformation and"tunnel"signs in the hepatic and spleen capsules. Conclusions Paragonimiasis westermani is a multiple organ system involved infection, and it has complex and varied clinical manifestations. The "tunnel" sign and serpentine deformations in the intracranial part, lung, liver and spleen are important imaging manifestations of the disease.
Objective To analyze the clinical manifestations and imaging characteristics of pulmonary and extra pulmonary paragonimiasis westermani. Methods A retrospective analysis was performed of 30 patients diagnosed by clinical features, laboratory serological tests and surgical pathology. Results The symptoms of the lung included mainly chest distress, fever, chest pain, cough and expectoration, and dyspnea. The extra pulmonary symptoms included abdominal pain, vomiting, diarrhea, poor appetite, emaciation, both lower extremities asthenia, headache, dizziness, epileptic seizures, and subcutaneous migratory masses. The laboratory examination showed that the eosinophil numbers of serum and pleural effusion of all the thirty patients were increased, and the eggs of Paragonimus westermani were found by the stool tests in four cases. The chest CT tests found abnormal nodules, ground glass changes, insect damages, pleural effusion, "tunnel" signs, and "halo" signs. Cranial CT and MRI showed intracranial hemorrhage foci, and extensive "finger-like" edema. Abdominal CT showed serpentine deformation and"tunnel"signs in the hepatic and spleen capsules. Conclusions Paragonimiasis westermani is a multiple organ system involved infection, and it has complex and varied clinical manifestations. The "tunnel" sign and serpentine deformations in the intracranial part, lung, liver and spleen are important imaging manifestations of the disease.
引文
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[11]Li XM,Yu JQ,He D,et al.CT evaluation of hepatic paragonimiasis with simultaneous duo denalorsplenic involvement[J].Clin Imaging,2012,36(4):341-394.
[12]Boland JM,Vaszar LT,Jones JL,et al.Pleuropulmonary infection by Paragonimus westermani in the United States:a rare cause of eosinophilic pneumonia after ingestion of livecrabs[J].Am J Surg Pathol,2011,35(5):707-713.
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[2]Kodama M,Akaki M,Tanaka H,et al.Cutaneous paragonimiasis due to triploid Paragonimus westermani presenting as a non-migratory subcutaneous nodule:a case report[J].J Med Case Rep,2014,8(1):346.
[3]Itoh N,Tsukahara M,Yamasaki H,et al.Paragonimus westermani infection mimicking recurrent lung cancer:A case report[J].J Infect Chemother,2016,22(12):815-818.
[4]Kalhan S,Sharma P,Sharma S,et al.Paragonimus westermani inChin J Schisto Control 2019Vol.31No.2fection in lung:A confounding diagnostic entity[J].Lung India,2015,32(3):265-267.
[5]Shim SS,Kim Y,Lee JK,et al.Pleuropulmonary and abdominal paragonimiasis:CT and ultrasound findings[J].Br J Radiol,2012,85(1012):403-410.
[6]杨戈.眼眶肺吸虫感染1例报告[J].国际眼科杂志,2006,6(4):942.
[7]罗婕,张娜,阎衡,等.皮肤结节型肺吸虫病1例[J].中国皮肤性病学杂志,2012,26(10):924-925.
[8]Kanpittaya J,Sawanyawisuth K,Vannavong AA,et al.Different chest radiographic findings of pulmonary paragonimiasis in two endemic countries[J].Am J Trop MedHyg,2010,83(4):924-926.
[9]胡杨红,詹学.肺吸虫病的诊治进展[J].中华临床医师杂志:电子版,2017,11(5):849-854.
[10]Seon HJ,Kim YI,Lee JH,et al.Differential chest computed tomography findings of pulmonary parasite infestation between the paragonimiasis and nonparagonimiatic parasite infestation[J].J Comput Assist Tomogr,2015,39(6):956-961.
[11]Li XM,Yu JQ,He D,et al.CT evaluation of hepatic paragonimiasis with simultaneous duo denalorsplenic involvement[J].Clin Imaging,2012,36(4):341-394.
[12]Boland JM,Vaszar LT,Jones JL,et al.Pleuropulmonary infection by Paragonimus westermani in the United States:a rare cause of eosinophilic pneumonia after ingestion of livecrabs[J].Am J Surg Pathol,2011,35(5):707-713.
[13]王自立,罗海翔,邓锻炼,等.不典型脑型肺吸虫病19例CT诊断分析[J].中国误诊学杂志,2011,11(10):2490.