Pulmoner nokardiyoz BT bulguları

Özet

Pulmoner nokardiyoz, özellikle hücresel bağışıklığı baskılanmış kişilerde görülen ve akciğer dışına, bilhassa merkezi sinir sistemine yayılabilen fırsatçı enfeksiyondur. BT'de en sık nodül veya kitle, konsolidasyon ve değişken kaviteleşme görülür; hiçbir patern tek başına Nocardia'yı tanımlamaz. İmmünsüpresyon zemininde kaviteli nodül veya kitleler nokardiyoz olasılığını düşündürebilir; tanı mikrobiyolojik veya histopatolojik incelemeyle doğrulanır. Malignite, tüberküloz ve diğer fırsatçı enfeksiyonlarla karıştırılması tanısal gecikmeye yol açabilir.

Faz ve pencere

HRCT tanısal: İnce kesit akciğer görüntülerinde orta ve periferik akciğerde nodül/kitle, konsolidasyon, kavite, buzlu cam ve bronş duvarı kalınlaşması gibi değişken bulgular görülebilir; zonal baskınlık tutarlı değildir.
Kontrastsız: Toraks BT'de nodül veya kitle, kavite, konsolidasyon ve plevral efüzyon gibi bulgular görülebilir.

Önerilen pencereler: Akciğer (G 1500 / M -600), Mediasten (G 350 / M 50).

BT bulguları

Orta zon ve periferik akciğerde birden fazla nodül; loblar arasında dağılım değişken olabilir.
Solid nodül ya da kitle içinde kalın duvarlı kavite veya küçük nekrotik alan.
Fokal ya da multifokal hava boşluğu konsolidasyonu; içinde hava bronkogramları seçilebilir.
Nokardiyozda buzlu cam opasiteleri ve interlobüler septal kalınlaşma görülebilir.
Nokardiyozda kaldırım taşı (crazy-paving) paterni görülebilir; bu bulgu tek başına tanısal değildir.
Bronş duvarı kalınlaşması ve eşlik eden hafif bronşiyolitik opasiteler.
Plevral kalınlaşma veya efüzyon; nadiren parankimal odaktan göğüs duvarına doğrudan uzanım.

Normalde

Normal akciğer parankiminde bronkovasküler demetler çevresinde fokal yumuşak doku yoğunluğu, kavite veya hava boşluğu konsolidasyonu bulunmaz; lobüler mimari ve plevral çizgi korunur. Nodül veya kitlenin boyutunu, kaviteleşmeyi ve çevresindeki buzlu cam opasitesi ya da konsolidasyonu değerlendirerek pulmoner nokardiyozda bildirilen morfolojik bulguları tanımlayın.

Normal BT ile kıyasla

Aynı bölgenin, kaynak veri setinde patoloji içermediği belirtilen bir BT incelemesini kesit kesit kaydırın; organ sınırlarını açarak anatomiyi hasta görüntüsüyle karşılaştırın. Küçük rastlantısal bulgular tümüyle dışlanmamıştır.

Kaynak: TotalSegmentator v2.01 veri seti (Wasserthal ve ark., Radiology: Artificial Intelligence 2023), CC BY 4.0, vaka s1278; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Tüberküloz: üst lob baskın kavite, sentrilobüler tomurcuklanan ağaç nodülleri ve eşlik eden nekrotik lenf düğümleri destekleyebilir.
İnvaziv aspergilloz: nötropenide nodül çevresi halo ve kama biçimli infarkt benzeri opasiteler görülebilir.
Nokardiyozun ayırıcı tanısında diğer enfeksiyonlar, vaskülit ve malignite de benzer konsolidasyon, kavite ve nodüller oluşturabilir.
Kaviteli akciğer kanseri pulmoner nokardiyozla karışabilir; nokardiyoz da kaviteli nodül veya kitlelerle akciğer kanserini taklit edebilir ve ayırım için mikrobiyolojik ya da histopatolojik inceleme gerekir.
Septik pulmoner emboli: ekstrapulmoner enfeksiyon odağıyla birlikte çoklu periferik nodüller, besleyici damar işareti ve kama biçimli opasiteler SPE'yi düşündürebilir.
Septik pulmoner embolide çoklu periferik nodüller, kaviteleşme ve kama biçimli opasiteler görülebilir; bu bulgular emboliyi düşündürebilir.

Tuzaklar

Nokardiyoz hem nodül hem kitle hem de konsolidasyon yapabilir; yalnız tek bir morfolojik paterne göre dışlamayın.
İmmünsüpresyon öyküsü görüntü yorumunu güçlendirir ancak immünkompetan hastada da nokardiyoz görülebilir.
Kaviteli nodüller tüberküloz veya maligniteyle karışabilir; nokardiyoz bu olasılıkların ayırıcı tanısında değerlendirilmelidir.
Nokardiyoz merkezi sinir sistemine yayılabilir; bu nedenle beyin tutulumu da değerlendirilmelidir.
Pulmoner nokardiyozda BT bulguları özgül değildir ve enfeksiyon santral sinir sistemine yayılabilir.

Kendini dene

İmmünsüpresif hastada çoklu kaviteli nodüller görülüyor. Bu paterne dayanarak BT ile Nocardia tanısı kesinleştirilebilir mi?
Cevabı göster
Hayır; görüntü paterni özgül değildir ve mikrobiyolojik doğrulama gerekir. Nokardiyoz nodül, kitle, konsolidasyon ve kavite yapabilir; bu bulgular başka enfeksiyonlarda da görülür. BT olasılığı düşündürür, ancak etken tanısı mikrobiyolojik incelemeyle doğrulanır.
Kaviteleşen nodülün göğüs duvarına kesintisiz uzandığı görülüyor. Hangi eşlikçi bulgu tanımlanmıştır?
Cevabı göster
Ekstrapulmoner uzanım. Parankim odağının plevrayı aşarak göğüs duvarı yumuşak dokusuna devam etmesi doğrudan ekstrapulmoner uzanımdır. Diğer terimler sırasıyla küçük hava yolu, fibrotik kistik ve sentrilobüler nodüler paternleri anlatır.

Kaynaklar

Bu sayfadaki 39 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 14 cümle bu karşılaştırmada düzeltildi (2026-10-09).

Pulmonary actinomycosis and pulmonary nocardiosis mimicking lung cancer: A case series and narrative reviewpmc.ncbi.nlm.nih.gov
Pulmonary nocardiosis in patients with underlying pulmonary alveolar proteinosis: a case series and review of the literaturepmc.ncbi.nlm.nih.gov
Pulmonary Nocardia otitidiscaviarum in immunocompetent individuals: a case series and literature reviewpmc.ncbi.nlm.nih.gov
Pulmonary Nocardiosis Due to Nocardia exalbida Infection Following Living-donor Liver Transplantationpmc.ncbi.nlm.nih.gov
The Findings of Pulmonary Nocardiosis on Chest High Resolution Computed Tomographypmc.ncbi.nlm.nih.gov
CT findings of pulmonary nocardiosis.pubmed.ncbi.nlm.nih.gov
Thyrotoxicosis followed by Hypothyroidism due to Suppurative Thyroiditis Caused by Nocardia brasiliensis in a Patient with Advanced Acquired Immunodeficiency Syndrome.pubmed.ncbi.nlm.nih.gov
Pulmonary melanoma and "crazy paving" patterns in chest images: a case report and literature review.pubmed.ncbi.nlm.nih.gov
The Findings of Pulmonary Nocardiosis on Chest High Resolution Computed Tomography: Single centre experience and review of literature.pubmed.ncbi.nlm.nih.gov
Pulmonary Nocardia otitidiscaviarum in immunocompetent individuals: a case series and literature review.pubmed.ncbi.nlm.nih.gov
Disseminated Nocardiosis in a Renal Transplant Recipient.pubmed.ncbi.nlm.nih.gov
Clinical characteristics of pulmonary nocardiosis in immunocompetent patients.pubmed.ncbi.nlm.nih.gov
Pulmonary nocardiosis: a clinical analysis of 59 cases.pubmed.ncbi.nlm.nih.gov
Clinical Analysis of Pulmonary Nocardiosis in Patients With Autoimmune Disease.pubmed.ncbi.nlm.nih.gov
Recurrent Empyema Thoracic Secondary to Pulmonary Nocardiosis in Immunocompetent Patients.pubmed.ncbi.nlm.nih.gov
A rare case of pulmonary nocardiosis comorbid with Sjogren's syndrome.pubmed.ncbi.nlm.nih.gov
Pulmonary nocardiosis caused by Nocardia exalbida mimicking lung cancer.pubmed.ncbi.nlm.nih.gov
[Clinical analysis of pulmonary nocardiosis associated with bronchiectasis].pubmed.ncbi.nlm.nih.gov
Septic arthritis caused by Nocardia asiatica: a case report and narrative review.pubmed.ncbi.nlm.nih.gov
Multiple Deep Abscesses Caused by Disseminated Nocardia farcinica Infection After Immunosuppressive Treatment for Membranous Nephropathy: A Case Report and Literature Review.pubmed.ncbi.nlm.nih.gov
Disseminated Nocardia paucivorans infection in a 64-year-old patient with first manifestation as an ulnocarpal forearm lesion.pubmed.ncbi.nlm.nih.gov
Pulmonary actinomycosis and pulmonary nocardiosis mimicking lung cancer: A case series and narrative review.pubmed.ncbi.nlm.nih.gov
Clinical and radiographic feature of pulmonary nocardiosis: A study of 102 cases.pubmed.ncbi.nlm.nih.gov
Bacterial Granulomatous Lung Diseases: Radiological Findings and Differential Diagnosis.pubmed.ncbi.nlm.nih.gov
Pulmonary Abscess With Contiguous Extension to the Chest Wall in an Immunocompetent Young Woman: A Case Report.pubmed.ncbi.nlm.nih.gov
Disseminated Nocardia farcinica with multiple cerebral abscesses in a patient receiving induction immunosuppression for autoimmune hepatitis: case report.pubmed.ncbi.nlm.nih.gov
Thoracic Actinomycosis: A Rare Cause of Pleural Thickening.pubmed.ncbi.nlm.nih.gov
Management of pneumonia by the emergency radiologist.pubmed.ncbi.nlm.nih.gov
Multiple pulmonary cavities as the prominent manifestation of diffuse large B-cell lymphoma: a case report.pubmed.ncbi.nlm.nih.gov
Comparative analysis of clinical characteristics of talaromycosis in HIV-positive and HIV-negative hosts: A single-center retrospective study from China.pubmed.ncbi.nlm.nih.gov
Concurrent Pulmonary Detection of Nocardia beijingensis, Mycobacterium tuberculosis, and Mycobacterium fortuitum in a Liver Transplant Recipient.pubmed.ncbi.nlm.nih.gov
The curious case of aplastic anemia: a fatal triple co-infection with Aspergillus, Mucorales, and Nocardia.pubmed.ncbi.nlm.nih.gov
Delayed Microbiological Diagnosis and Fluoroquinolone-Associated Tendon Rupture in Pulmonary Nocardiosis Complicating Autoimmune Pulmonary Alveolar Proteinosis: A Case Report.pubmed.ncbi.nlm.nih.gov
Beyond Pneumonia: Autoimmune Pulmonary Alveolar Proteinosis in a Pediatric Patient.pubmed.ncbi.nlm.nih.gov
A case of autoimmune pulmonary alveolar proteinosis in a patient with chronic nicotine vaping exposure.pubmed.ncbi.nlm.nih.gov
Case Report: The "atoll sign": a case series on an unusual radiological pattern of immune-mediated pneumonitis.pubmed.ncbi.nlm.nih.gov
Nocardia cyriacigeorgica Identified by Bronchial Washing During Evaluation of Radiologic Progression in a Patient With Prior Nontuberculous Mycobacterial Diseases.pubmed.ncbi.nlm.nih.gov
Clinical characterization and etiological insights: a small cohort study of pulmonary infections caused by Microascus spp. in critically ill patients.pubmed.ncbi.nlm.nih.gov
AWMF S2k Guideline: Diagnosis and Assessment of Lung Disease Caused by Occupational Silica Dust Exposure (Silicosis) - Disease No. 4101 as per Occupational Diseases Ordinance (BKV) Annex 1.pubmed.ncbi.nlm.nih.gov
The first CT-based classification system for pulmonary actinomycosis: correlating imaging patterns with therapeutic strategies and prognosis in a highly misdiagnosed disease.pubmed.ncbi.nlm.nih.gov
A Cone Beam CT Bronchoscopy Study of the Ultrathin Cryoprobe for Biopsy of Peripheral Lung Lesions.pubmed.ncbi.nlm.nih.gov
Pneumonia in normal and immunocompromised children: an overview and update.pubmed.ncbi.nlm.nih.gov
Antifungal Management in Patients with Hematological Malignancies: From Primary Prophylaxis to Empirical and Diagnosis-Driven Treatmentpubmed.ncbi.nlm.nih.gov
Granulomatosis With Polyangiitis (GPA) Mimicking Metastatic Malignancy.pubmed.ncbi.nlm.nih.gov
Chest Imaging in Systemic Endemic Mycoses.pubmed.ncbi.nlm.nih.gov
Pulmonary Aggregatibacter actinomycetemcomitans infection masquerades as malignancy in a patient with periodontitis.pubmed.ncbi.nlm.nih.gov
Imaging Approach to Pulmonary Infections in the Immunocompromised Patient.pubmed.ncbi.nlm.nih.gov
Imaging spectrum of pulmonary infections in renal transplant patients.pubmed.ncbi.nlm.nih.gov
CT findings of COVID-19-associated pulmonary aspergillosis: a systematic review and individual patient data analysis.pubmed.ncbi.nlm.nih.gov
Pulmonary Manifestations in Patients With Hematologic Malignancies: In Pursuit of an Accurate Diagnosis.pubmed.ncbi.nlm.nih.gov
When metagenomic next-generation sequencing detects Nocardia: from clinical interpretation to immune-based clinical management.pubmed.ncbi.nlm.nih.gov
Diagnostic Performance of Bronchoalveolar Lavage Fluid Metagenomic Next‑generation Sequencing versus Conventional Microbiological Tests in Immunocompromised and Immunocompetent Patients with Pulmonary Infection.pubmed.ncbi.nlm.nih.gov
Nocardia farcinica pituitary abscess in an immunocompetent patient: illustrative case.pubmed.ncbi.nlm.nih.gov
Disseminated Nocardia farcinica Infection Presenting as Multiple Intramuscular Abscesses Mimicking Skeletal Muscle Metastases in a Patient With Hepatocellular Carcinoma.pubmed.ncbi.nlm.nih.gov
First human infection caused by Nocardia gipuzkoensis in Japan.pubmed.ncbi.nlm.nih.gov
Disseminated Nocardia otitidiscaviarum Presenting as Lung-Brain-Skin Syndrome in a Renal Transplant Recipient: A Case Report.pubmed.ncbi.nlm.nih.gov
Multifocal skeletal tuberculosis with posterior-element spinal, sternal, and pelvic involvement presenting as a pulmonary mass: A malignancy mimic.pubmed.ncbi.nlm.nih.gov
Long-Term Survival Following Nivolumab Treatment in Pulmonary Tumour Thrombotic Microangiopathy Associated With Cancer of Unknown Primary: A Case Report.pubmed.ncbi.nlm.nih.gov
Acute Endobronchial Dissemination of a Tuberculoma Following EBUS-GS-Guided Transbronchial Biopsy: A Case Report.pubmed.ncbi.nlm.nih.gov
Rare clinical presentation of invasive pulmonary aspergillosis in patient with early-stage lung cancer: a case report.pubmed.ncbi.nlm.nih.gov
Invasive Pulmonary Aspergillosis-Mimicking Pseudomonas aeruginosa Pneumonia in Immunocompromised Patients: Radiologic Differentiation.pubmed.ncbi.nlm.nih.gov
Mixed Invasive Aspergillus-Mucorales Pulmonary Coinfection in a Diabetic Patient: An Uncommon Dual Fungal Pneumonia and Literature Review.pubmed.ncbi.nlm.nih.gov
Host, Pathogen, and Pulmonary Anatomy in Pneumonia: An Integrated Imaging and Clinical Perspective.pubmed.ncbi.nlm.nih.gov
Right-Sided Empyema Thoracis Mimicking Pulmonary Tuberculosis Secondary to a Complicated Hepatic Cyst: A Diagnostic Pitfall.pubmed.ncbi.nlm.nih.gov
Therapeutics in hepatobronchial fistula caused by microwave ablation for the treatment of recurrent hepatic carcinoma: A case report.pubmed.ncbi.nlm.nih.gov
Lung squamous cell carcinoma complicated with immune checkpoint inhibitor-associated active tuberculosis: a case report and literature review.pubmed.ncbi.nlm.nih.gov
Diagnostic Performance of 3.0-Tesla Magnetic Resonance Imaging for Pulmonary Nodules and Masses: A Comparative Cross-Sectional Study With Multidetector Computed Tomography.pubmed.ncbi.nlm.nih.gov
CT imaging features of pulmonary SMARCA4-deficient undifferentiated carcinoma: a retrospective case series.pubmed.ncbi.nlm.nih.gov
Non-thrombotic pulmonary emboli: imaging findings and differential diagnoses.pubmed.ncbi.nlm.nih.gov
Patent ductus arteriosus with pulmonary endarteritis leading to pulmonary infarction in a 9-year-old boy: a case report.pubmed.ncbi.nlm.nih.gov
Septic Pulmonary Embolism Secondary to Klebsiella Pneumonia Perianal Abscesses: A Case Report.pubmed.ncbi.nlm.nih.gov
Has computer-aided diagnosis now outperformed radiologists in the accurate localization of lung nodules?-a multicenter retrospective study.pubmed.ncbi.nlm.nih.gov
Bronchoscopy and the Pulmonologist in Contemporary Lung Cancer Care.pubmed.ncbi.nlm.nih.gov
Radiological pure-solid appearance clinical stage I lung adenocarcinoma: a comparative study of mucinous and non-mucinous adenocarcinoma based on imaging features and survival outcomes.pubmed.ncbi.nlm.nih.gov
Anesthetic management of a patient with acquired bronchobiliary fistula: a case report.pubmed.ncbi.nlm.nih.gov
A Case of Disseminated Nocardiosis due to Nocardia otitidiscaviarum With Pulmonary Infection and a Thyroid Abscess.pubmed.ncbi.nlm.nih.gov
Case Report: pharmaceutical care in a case of complicated urinary tract infection combined with disseminated Nocardia brasiliensis infection.pubmed.ncbi.nlm.nih.gov
A 56-Year-Old Woman With Systemic Lupus Erythematosus on Trimethoprim-Sulfamethoxazole Prophylaxis Presenting With Breakthrough Nocardiosis.pubmed.ncbi.nlm.nih.gov
High-resolution CT findings of patients with pulmonary nocardiosis.pubmed.ncbi.nlm.nih.gov
Pulmonary nocardiosis in patients with underlying pulmonary alveolar proteinosis: a case series and review of the literature.pubmed.ncbi.nlm.nih.gov
Pulmonary Nocardia farcinica Infection in a Non-immunocompromised Patient With Fibrotic Nonspecific Interstitial Pneumonia (NSIP).pubmed.ncbi.nlm.nih.gov
Concurrent Nocardia, Cryptococcus and Mycobacterium Infections Unmask Anti-GM-CSF Antibody-Associated Immunodeficiency and Pulmonary Alveolar Proteinosis: A Case Report.pubmed.ncbi.nlm.nih.gov
Imaging characteristics, yield of computed tomography, and clinical outcomes of central nervous system nocardiosis.pubmed.ncbi.nlm.nih.gov
Morphological patterns of pneumonia in free-roaming cats: a necropsy and histopathological study.pubmed.ncbi.nlm.nih.gov
Disseminated life threatening Nocardia otitidiscaviarum infection in a young female with newly diagnosed systemic lupus erythematosus, case report and review of literature.pubmed.ncbi.nlm.nih.gov
Cavitary pulmonary disease.pubmed.ncbi.nlm.nih.gov
In vitro expanded human CD4+CD25+ regulatory T cells suppress effector T cell proliferation.pubmed.ncbi.nlm.nih.gov
Pulmonary Nocardia paucivorans Infection Mimicking Lung Cancer in an Immunocompetent Patient: A Case Report.pubmed.ncbi.nlm.nih.gov
Case Report of a Solitary Brain Abscess due to Nocardia veterana in a Host Without Known Immunodeficiency.pubmed.ncbi.nlm.nih.gov
Arbor Accidents and Asteroids.pubmed.ncbi.nlm.nih.gov
Spectrum of imaging findings in pulmonary infections. Part 1: Bacterial and viral.pubmed.ncbi.nlm.nih.gov
Guidelines for Antibiotics Prescription in Critically Ill Patients.pubmed.ncbi.nlm.nih.gov
Tuberculosis exposure, infection and disease in children: a systematic diagnostic approach.pubmed.ncbi.nlm.nih.gov
Infections after lung transplantation.pubmed.ncbi.nlm.nih.gov
Uncommon Causes of Interlobular Septal Thickening on CT Images and Their Distinguishing Features.pubmed.ncbi.nlm.nih.gov
Septic pulmonary embolism with spontaneous bilateral pneumothorax complicating facial cellulitis in an immunocompetent patient: a rare case report.pubmed.ncbi.nlm.nih.gov
Culture-Negative Septic Pulmonary Embolism Secondary to Lower-Limb Cellulitis Following Recent Dengue Fever Complicated by Hydropneumothorax: A Case Report.pubmed.ncbi.nlm.nih.gov
A silent journey from kidney to lungs: pyelonephritis triggering septic pulmonary embolism - a rare case report from Nepal.pubmed.ncbi.nlm.nih.gov
An overview of case reports and case series of pulmonary actinomycosis mimicking lung cancer: a scoping review.pubmed.ncbi.nlm.nih.gov
Thoracic diseases associated with HIV infection in the era of antiretroviral therapy: clinical and imaging findings.pubmed.ncbi.nlm.nih.gov

Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.