AIDS相关胸部疾病的影像诊断.ppt

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1、艾滋病相关胸部疾病的影像诊断ImagingofthethoraxinAIDS上海复旦大学附属公共卫生临床中心Shanghaiaffiliatedpublichealthcentre施裕新张志勇王桂龙shiyuxinzhangzhiyongwangguilong背景Background发病率：大多数，新AIDS>50%Morbidity:50%ofnewAIDSpresentation意义:致病率和死亡率的重要原因Meaning:importantcauseofmorbidityandmortality新特点:1

2、.治疗抗病毒和预防性抗生素Newfeature:Tharapycombinationanti-retroviraltherapyandtheuseofprophylacticantibiotics2.病原体传统(PJP),少见（巨毒及鸟分菌)Pathogentradition(PJP),lesscommon(CMVandMAC)3.人群妇女、儿童Populationcharacteristicswomenandchildren背景Background4.影像:多样,重叠Radiologicalap

3、pearances:varietyandoverlap5.影像结合临床:Imagingbeinterpretedinconjuctionwithclinicalinformation获得背景，并发症，CD4+细胞数，治疗缓急程度血氧分析和痰菌培养NatureofHIVacquisition,previousinfectionsornon-infectionscomplications,CD4+cellcount,currentdrugtherapy,andacutenessofonsetandseverityo

4、ftheillness,pulseoximetryandsputummicroscopyCD4细胞计数与肺部并发症CD4细胞计数（×106个/L）肺部病原体(种类、表现)>200细菌性肺炎结核（继发性）肺癌50－200细菌性肺炎结核（原发性）肺癌肺孢子虫肺炎Kaposi肉瘤淋巴瘤真菌感染弓形体病杆菌性血管瘤病<50细菌性肺炎结核（非典型）肺癌肺孢子虫肺炎Kaposi肉瘤淋巴瘤真菌感染弓形体病杆菌性血管瘤病鸟型分枝杆菌巨细胞病毒RelationshipbetweendecliningCD4+countandons

5、etofHIV-associatedpathologiesCD4+cellcount(×10-6cellsI-1)Pulmonarypathology＞200BacterialpneumoniaTB(re-infection)Lungcarcinoma50–200BacterialpneumoniaTB(primary)LungcarcinomaPCPKSLymphomaFungalinfectionsToxoplasmosisBacillaryangiomatosis＜50Bacterialpneumonia

6、TB(atypicalappearances)LungcarcinomaPCPKSLymphomaFungalinfectionsToxoplasmosisBacillaryangiomatosisMACCMVTB,Tuberculosis;PCP,Pneumocystiscariniipneumonia;KSKaposi’ssarcoma;MAC,Mycobacteriumaviumcomplex;CMV,cytomegalovirus.影像价值TheroleofCTl确定病变Confirmingsuspec

7、tedchestdiseasel鉴别诊断Differentialdiagnosisl活检或胸腔引流Advisingonandperformingthoracicinterventionssuchasbiopsyorchestdrainagel疗效检测及随访MonitoringtheresponsetotherapyfollowingdiagnosisCTCT>普通胸片CTissuperiortoplainchestradiographyCT确诊率不高,约50%AccuracyofCTinthediagnosis

8、ofthoraciccomplicationsofAIDSlow,about50%确定病变，胸片-/Confirmingsuspectedchestdisease定性诊断Clarificationofabnormalitiesidentifiedonplainchestradiographs病变范围和形态Theextentofdiseaseandthepatternofparench