pulmonary echinococcosis examination, diagnosis of pulmonary echinococcosis
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Common examinations for pulmonary hydatid disease
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2. Eosinophil allergy test
Has clinical significance. The method is 30 minutes after subcutaneous injection of 0.3ml hydatid cyst fluid, blood is drawn, if eosinophilic blood
A transient decrease in cell count (a decrease of 0.1 or more than before the injection of hydatid cyst fluid) was considered positive.
3. Indirect hemagglutination test (IHA)
The specificity is high, and the positive rate can reach 80%. It is mostly used for census and screening of specimens.
4. Hydatid cyst fluid intradermal test (cosoni test)
The positive rate can reach 90% to 95%.
5. Complement fixation test
The impotence rate can reach 70% to 90%. The diagnostic value of this method is small, but it is helpful for judging the curative effect. If the complement fixation test is still positive one year after the operation, it indicates that there are still hydatid cysts in the body.
6. Convection immunoelectrophoresis (EIED) is used for general survey and screening of all specimens.
7. Latex agglutination test (LA).
8. Enzyme-linked immunosorbent test (EICB).
9. Dot enzyme-linked immunosorbent test (BOT-EICB) is a diagnostic test.
Immunodiagnostic examination is very useful for diagnosing Echinococcus. The combination of multiple examination results is currently the most valuable serological diagnosis, which can be used before invasive examination. The above-mentioned immunoassay is mainly used to detect antibodies, with a positive rate of 80% to 90% and a false positive rate of 5% to 10%. The main factors affecting the immune response are the specificity of the antigen and the unsatisfactory sensitivity. False positive reactions can be seen in patients infected with other intestinal parasitic diseases, cancers, and chronic immune diseases. Negative results cannot exclude hydatidosis, because some cyst carriers cannot detect antibodies and detect immune response and larval cysts. Location, integrity and activity are related. Pay special attention to the following points:
①Intrahepatic cysts are easier to activate antibody response than lung cysts. If the site is ignored, antibody examination is the least sensitive to intact Echinococcus granulosus cysts;
②The diagnosis rate of cysts in the lung, brain, and spleen is low, while cysts in the bone are more likely to stimulate the antibody response;
③The cystic fistula or rupture can stimulate sudden antibody response;
④The cysts with decay, calcification or death are often negative in serological examination.
10. X-ray inspection
Chest X-ray examination is the main diagnostic method for hydatid disease. In endemic areas, there is a clear history of exposure, and most of them can be diagnosed by chest X-ray alone. Cysts with a diameter of less than 1 cm in the early stage can only see inflammatory shadows with fuzzy edges. Those with a diameter of> 2 cm are round-shaped shadows with clear outlines and sharp edges. The density is uniform and slightly lighter, which is lower than that of the heart and solid tumors. It has been 6-10 cm by the time the diagnosis can be made, and the density of solid tumors is close to that of solid tumors, which are usually single or multiple.
As a fluid-containing cyst, the diaphragm decreases during inhalation and the head and foot diameters increase slightly when the exhalation diaphragm rises. When the exhalation diaphragm rises, the transverse diameter is slightly longer and the upper and lower sides are slightly shorter ("hydatid respiratory sign"). Larger cysts open up the lung texture, and the surrounding lung texture is a cord around the hilar side of the cyst ("ball holding sign"). Large cysts can be lobulated or multi-ring. Cysts in the lower lung field "sit" on the diaphragm, causing the diaphragm to drop or even sink. Sometimes an artificial pneumoperitoneum is required to determine whether it is an intrathoracic cyst. Large cysts in the upper lung often push the mediastinum to the opposite side, and the mediastinum in the lower lobe is less affected, while the large cyst at the top of the right liver obviously shifts the heart to the left. This feature is helpful for differential diagnosis. A few cases have atelectasis and pleurisy.
If the small bronchus of the cyst is invaded and penetrated, and a small amount of gas enters between the inner and outer cysts, some special X-ray signs will appear:
① A small amount of gas enters between the inner and outer capsules, and the gas rises to the upper part of the cyst in the standing X-ray film, and there is an arc-shaped zona pellucida ("Crescent sign") locally.
② If the gas further enters the inner capsule, a liquid level appears, and two arc-shaped shadows representing the inner capsule and the outer capsule ("double bow sign") are seen above it.
③When the inner capsule ruptures and collapses, the shrunken inner capsule floats on the liquid surface, and irregular shadows can be seen on the liquid surface in the capsule ("floating lotus sign on water").
If the cyst is ruptured, the contents have been coughed up, and no infection has occurred. The chest radiograph shows a thin-walled swelling with sacs with smooth edges. Later, the cyst cavity gradually shrinks, leaving only some fibrosis shadows. If infection occurs after the cyst is ruptured, the cyst wall will thicken, and there will be visible lung infiltrates with chronic inflammation around it. If it breaks into the chest cavity, there is pleural effusion or liquid pneumothorax.
11. CT or B-ultrasound examination
It can be seen that the partition structure in the cyst is the characteristic of the active cyst. The image of the lung showed a round mass. CT confirmed that the mass was filled with fluid, and the positive rate of serology for hepatic cysticercosis was low. According to the pathological morphology of hydatid cysts and the imaging characteristics of complications, combined with clinicopathological classification, they are divided into 5 types:
(1) Single hairstyle: Because the hydatid cyst is filled with watery sac fluid, the edges are neat in B-ultrasound, CT and MRI imaging, showing a round or oval isolated liquid occupying shadow. Its realm is clear, its density is uniform, and its size varies. It is generally 2 to 8 cm, and it is more common in the right and lower lungs. Hydatid cyst wall and lung tissue density are quite different, and present
There is a well-defined, smooth cyst wall. In larger hydatid cysts, there is a potential gap interface between the inner and outer cyst walls, and double-wall signs may appear.
(2) Multiple types: Two or more images with characteristics of hydatid cysts are detected in the lungs, separated by lung tissue or hydatid cyst wall.
(3) Calcified type: Hydatid cysts with a long course of disease have thick and rough outer cysts with calcium salt deposition, or even complete calcification. Most of the hydatid cysts have died and died, and the cyst fluid is purulent. Hydatid cyst density is high and uneven, and the cyst wall is thick and irregular, accompanied by wide sound shadow and side wall sound shadow. CT and MRI showed a shell-like edge, and the CT value was >60HU.
(4) Infectious type: secondary infection in the hydatid sac becomes pus, due to necrosis and collapse of the sac and part of the ascus, mixed in the pus, the density increases, and the necrotic tissue inside appears flocculent or patchy. shadow. After CT enhancement, the CT value of the surrounding tissues of the hydatid cyst increased, but the hydatid cyst did not increase.
(5) Fracture type:
①The rupture of the outer capsule communicates with the bronchus, and a small amount of air enters between the inner and outer capsules, forming a star-moon-shaped translucent shadow;
②The inner and outer capsules rupture at the same time and communicate with the bronchus. When air enters the inner and outer capsules, a liquid level appears. There is a double-arc translucent zone above it, this sign has diagnostic value;
③The internal and external cysts are completely ruptured, the internal cyst collapses and floats on the liquid surface, making the gas and liquid surface uneven, such as "floating lotus on water" also known as "floating lotus sign on water", this sign is a typical CT of hydatid cyst rupture Performance;
④If the liquid part of the sac is coughed out, the cyst cavity shrinks, and the cyst wall is folded, the CT value is very high, and it is difficult to distinguish from the solid mass in the lung. If the sac content is completely coughed up, a spherical thin-walled cavity may be formed Cavity;
⑤ Pulmonary hydatid cysts appear as thickening of the cyst wall after infection. If there is a bronchopleural fistula, it can cause liquid pneumothorax, or empyema or empyema due to infection;
⑥ Pulmonary outsculpted cysts, CT found pulmonary hydatid cysts, which is very helpful in the diagnosis. For lung hydatid cysts, chest puncture is contraindicated as a diagnostic method, because puncture can cause cyst fluid extravasation and produce hypersensitivity or hydatid Serious complications such as cyst dissemination.
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