Preliminary Study Of CT Manifestations With Pulmonary Infection After Hematopoietic Stem Cell Transplantation

Part one:Preliminary study CT manifestations of pulmonary bacterialinfection following hematopoietic stem cell transplantationObjective To investigate the computed tomography manifestations of pulmonarybacterial infection following haemopoieic stem cell transplantation and Analysis of theincidence of pathogens.Materials and Methods Collect the People’s Liberation Army307Hospitalhematopoietic stem cell transplantation complicated by pulmonary bacterial infection inpatients with93cases,60cases were male and33females, median age34.7years (8-72years). Underlying disease and27cases of acute myelogenous leukemia, acutenon-lymphocytic leukemia,13cases,10cases of acute lymphoblastic leukemia,11cases of aplastic anemia, myelodysplastic syndrome,10cases,8cases of chronicmyeloid leukemia, acute leukemia cases, three cases of multiple myeloma, two cases ofacute heterozygous leukemia, non-Hodgkin’s lymphoma, T-lymphoblastic leukemia,acute monocytic leukemia1cases. Use of U.S. company GE Light, the Speed64theVCT scanner; patient supine, conventional inspiratory scan, since the end of the apexscan to the lung, the voltage:120kv, current101mAs, collimator width of40mm (64×0.625mm) pitch.984:1, FOV:50cm, reconstruction slice thickness5mm, the interlayerspacing0mm, matrix512×512, bandwidth of the lung window1400HU, window level550HU, statistical processing with SPSS18.0software, the overall rate of fourfold tablec2test, test, P <0.05was considered statistically significant difference. Results93patients, complicated by pulmonary bacterial infection in152cases, mixedinfections accounted for64cases (42.1%), Gram-negative bacteria (G-) accounted for57(37.5%), Gram-positive bacteria (G+) accounted for27(17.8%). Which granulocytecells decrease of82cases (53.9%), transplantation of early27cases (17.8%), transplantlate in43cases (28.3%).Hematopoietic stem cell transplantation for pulmonary bacterial infection CT form ofthe performance of a gas chamber-like opacities, ground-glass opacities, small nodules,nodules, grid-like or wire-like shadow.152cases of pulmonary bacterial infectionpatients, the gas chamber-like opacities in95cases (62.5%), ground-glass opacities in61cases (40.1%), small nodules,45cases (29.7%), large nodules14cases (9.2%),grid-like or line opacities in23cases (15.1%).57cases of G-bacteria infection, gas chamber-like real opacities (39cases),ground-glass opacities (23cases), small nodules (21cases), large nodules (3cases), andgrid-likeor linear opacities (five cases) and other signs of a rate of68.4%,40.3%,36.8,5.2%and8.7%;27cases of G+bacteria infection in the gas chamber-like solidopacities (21cases),ground-glass opacities (17cases), small nodules (11cases), largenodules (3cases) and the grid-like or linear opacities (four cases) and other signs of theemergence rate of77.7%,62.9%40.7%,11.1%and14.8%respectively. Variety of signsin G+bacteria, G-bacteria infection rate compared to no significant difference (P>0.05).Hematopoietic stem cell transplantation for pulmonary bacterial infection of the lesionsseen distributed in the bilateral, unilateral, on the lung, in lung, lower lung or wholelung.152cases of pulmonary bacterial infections in patients with bilateral in104cases(68.4%), unilateral in48cases (31.6%); lobe in26cases (17.1%), lobectomy in15cases (9.7%) lower lobes in49cases (32.2%), and more divergent in or diffusedistribution in62cases (40.8%).Conclusion This group of hematopoietic stem cell transplantation cases of lungbacterial infection common CT manifestations of the gas chamber-like real opacitiesand ground glass, a small number of nodules and the grid or line opacities, the lesionslocated in the bilateral compared with unilateral commonwhole lung and lower lobes than on the lung or in lung common with transplant recipients time and laboratory teststo help identify with the other pulmonary complications.Hematopoietic stem cell transplant pulmonary bacterial infection common in mixedinfections, followed by Gram-negative bacteria, the lung bacterial infection oftenoccurs after transplantation, neutropenia and transplant late Part two:Preliminary study CT manifestations of pulmonary Fungalinfection following hematopoietic stem cell transplantationObjective: Preliminary analysis of the hematopoietic stem cell transplantation afterpulmonary fungal infection (IFI), CT findings and fungal following transplantation theincidence of, and provide a reference for the clinical diagnosis and treatment.Materials and Methods: Retrospective analysis of184cases of hematopoietic stemcells after transplantation of various types of pulmonary complications in patients withclinical and chest CT data, All cases from the People’s Liberation Army307Hospital,184cases of patients with pulmonary fungal infection in108cases,108cases of fungalinfections in patients,51cases of men and57women with a mean age of34.65yearsold.108cases of confirmed fungal infections In39cases, the clinical diagnosis of53cases, diagnosed of16cases.108cases of fungal infections in patients as the studygroup, The remaining76cases of other pulmonary infectious and noninfectiouspulmonary complications in patients as a control group.184cases of patients withprimary lesions on the basis of dry cough, expectoration, fever, chest pain and othersymptoms. Clinical symptoms appear the48h experts chest CT. OUse of U.S. companyGE Light, the Speed64the VCT scanner; patient supine, conventional inspiratory scan,since the end of the apex scan to the lung, the voltage:120kv, current101mAs, collimator width of40mm (64×0.625mm) pitch.984:1, FOV:50cm, reconstructionslice thickness5mm, the interlayer spacing0mm, matrix512×512, bandwidth of thelung window1400HU, window level550HU, Germany’s Siemens, the production ofSensation4spiral CT scanning, the scanning conditions:120kV/180mA. FOV:50cmscan reconstruction thickness of10mm, pitch1.25.statistical processing with SPSS18.0software, the overall rate of fourfold tablec2test, test, P <0.05was consideredstatistically significant difference.our study group of108cases of patients with fungalinfections and other complications of the lungs of the control group the various CTcharacteristics were statistically analyzed and compared in order to identify the fungalinfection typical CT findings.Results In108patients with fungal infection in39cases, Aspergillus, Mucor(39/108,36.1%)30(30/108,27.8%),(26/108,24.07%),26cases of Candida and otherfungal infection in13cases (13/108,12.03%). Occurs in transplantation neutropeniaperiod (before30days after transplantation)(61/108,56.4%) in61cases.After transplantation pulmonary fungal infection in a variety of CT findings: This group49cases (49/108,45.3%), halo sign, compared with the control group difference wasstatistically significant (P <0.05). Air crescent sign in this group of patients of47cases,appear in about two weeks after the anti-fungal treatment, air crescent grabbing43.5%,Appear in about two weeks after the lesions were found.compared with the controlgroup difference was statistically significant (P <0.05). Lobe and lung segmentconsolidation (43/108,39.8%), nodules and mass (41/108,37.9%), the latter two CTfindings and the control group showed no significant difference.Conclusion The halo sign and air crescent sign is characteristic CT manifestations ofpulmonary fungal infection of the transplant recipients, while the CT halo sign isgenerally early in the infection, the air crescent sign usually appear late; duringtreatment, indicating effective treatment;fungal infections can also occur lobe lungopacities, nodular or mass.