Abstract:

Objective

To explore the ultrasonic imaging characteristics of pulmonary lesions in multiple microbial pulmonary infections （MMPI） and evaluate the clinical value of ultrasound-guided percutaneous lung biopsy （UGPLB） in these conditions.

Methods

Two hundred and sixty-two patients with suspected MMPI from August 2012 to February 2024 at the Fourth People's Hospital of Nanning were selected. After chest CT and ultrasound examinations， UGPLB was successfully implemented for peripheral lung lesions， and the obtained lung lesion samples were subjected to histopathological examination and pathogen detection. The patients were divided into either an MMPI group or a single pathogen pulmonary infection （SPPI） group according to the confirmed pathogen（s）. The ultrasonic manifestations were compared between the MMPI group and SPPI group using the χ² test， and the relevant clinical data were comprehensively analyzed.

Results

All lung lesions were successfully obtained by UGPLB for pathological diagnosis and pathogen detection. Among the 262 patients， 210 were finally diagnosed with MMPI， of which the pathogen combination was mainly Mycobacterium tuberculosis + Marneffei basket （59 cases）， followed by Mycobacterium tuberculosis + Rhodococcus equi （44 cases）， Mycobacterium tuberculosis + Cryptococcus（37 cases）， and Mycobacterium tuberculosis + Klebsiella pneumoniae （36 cases）； 52 patients were diagnosed with SPPI， and the main pathogen was Mycobacterium tuberculosis （22 cases）， followed by Marneffei basket（14 cases）. One hundred and sixty-seven cases （79.52%） in the MMPI group and 18 cases （34.62%） in the SPPI group has a mean lung lesion size of ≥50 mm as measured by ultrasound， and there was a significant difference between the two groups （χ²=40.506， P＜0.001）. There were 132 cases （62.86%） in the MMPI group and 11 cases （21.15%） in the SPPI group with mixed solid and liquid echo in the lung lesions， and there was a significant difference between the two groups （χ²=29.240， P＜0.001）. There was no significant difference in the boundary of lung lesions， internal blood flow signal， or complication with pleural effusion between the two groups （P＞0.05）.

Conclusion

The characteristics of chest ultrasound in patients with MMPI are that the volume of lung lesions is large， and most of them showed mixed echo of solid and liquid， but there was no obvious specificity. For patients with clincially highly suspected MMPI， UGPLB is effectively helpful for the precise and differential diagnosis of MMPI.

Key words: Multiple microbial pulmonary infections, Ultrasound, Intervention, Lung biopsy