CT CT CT CT CT CT. (secondary lobulus) Miller 9) Vol. 19 No ( ) 6 7 1

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1 CT CT CT CT I ) CT CT X CT (8.2 ) X CT ( ) TEL: FAX: ystgc@tokyo-med.ac.jp 2) CT 3) 4) 5) CT 6) CT CT 7, 8) CT CT CT CT X CT II. HRCT CT (secondary lobulus) (lobulus) (acinus) Miller 9) CT 10 Vol. 19 No

2 CT 77 10) Miller 1 1. Miller 9 1 Miller 3 24 Miller CT Reid 11, 12) Reid Reid 11) mm Reid 3 5 Miller Miller cm Reid 10 mm CT 0.5 mm 0.5 mm 3 CT HRCT 2. Reid A B 10 Vol. 19 No

3 78 3. HRCT 0.1 mm mm HRCT 0.1 mm 10) 0.5 1mm mm HRCT HRCT HRCT CT Y Reid Miller III. Streptococcus pneumoniae ( ), Haemophilus influenzae ( ) Staphylococcus aureus ( ), Klebsiella pneumoniae ( ), Moraxella catarrhalis ( , 14) Streptococcus pneumoniae Klebsiella pneumoniae 7) S 2,S 6,S 10 HRCT 15, 16) X HRCT 1. Kohn Lambert CT 4 CT CT 12 Vol. 19 No

4 CT CT air bronchogram CT (air bronchogram) bulging fissure sign (Swiss cheese appearance) HRCT CT 5 CT air bronchogram 3. Vol. 19 No

5 80 6. CT 7. HRCT CT 6 feeding vessel sign (pneumatocele) check valve IV (atypical pneumonia) b- Mycoplasma pneumoniae Chlamydophila pneumoniae Legionella pneumophila b- 1) CT CT 1. Mycoplasma pneumoniae lipoprotein 17) lipoprotein Toll-like receptors (TLRs) 18 20) 14 Vol. 19 No

6 CT HRCT X CT CT Reid , 8, 21) 7 9 7, 8, 21) , 8, 21) 82, 73 22) 2. Chlamydophila pneumoniae Chlamydia pneumoniae CT 8 13, 14) COPD CT 88 8) 9 8) COPD Legionella pneumophila 2 5 mm II di#use alveolar damage (DAD) 23) Vol. 19 No

7 (69 ) 9 8 (22 ) 2 1 V CT CT CT V 1) p. 2 35, 2) CT 57: ) Fine, M. J., M. A. Smith, C. A. Carson, et al Prognosis and outcomes of patients with community-acquired pneumonia. A meta-analysis. JAMA 275: ) Hasley, P. B., M. N. Albaum, Y. H. Li, et al Do pulmonary radiographic findings at presentation predict mortality in patients with community-acquired pneumonia? Arch. Intern. Med. 156: ) Rello, J., R. Rodriguez, P. Jubert, et al Severe community-acquired pneuimonia in the elderly: Epidemiology and prognosis. Clin. Infect. Dis. 23: ) Niederman, M. S., L. A. Mandell, A. Anzueto, et al Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am. J. Respir. Crit. Care Med. 163: ) Reittner, P., S. Ward, L. Heyneman, et al Pneumonia: High-resolution CT findings in 114 patients. Eur. Radiol. 13: ) Nambu, A., A. Saito, T. Araki, et al Chlamydia pneumonia: Comparison with findings of Mycoplasma pneumoniae and Streptococcus pneumonia and thin-section CT. Radiology 238: ) Miller, W. S The lung. Springfield, III: Thomas. p ) Webb, W. R Thin-section CT of the secondary pulmonary lobule: Anatomy and the image. The 2004 Fleischner lecture. Radiology 239: ) Reid, L., G. Simon The peripheral pattern in the normal bronchogram and its relation to peripheral pulmonary anatomy. Thorax 13: ) Reid, L The secondary pulmonary lobule in the adult human lung, with special reference to its appearance in bronchograms. Thorax 13: ) Saito, A., S. Kohno, T. Matsushima, et al Prospective multicenter study of the causative organisms of community-acquired pneumonia in adults in Japan. J. Infect. Chemother. 12: ) Ishida, T., T. Hashimoto, M. Arita, et al A 3-year prospective study of aurinary antigendetection test for Streptococcus pneumoniae in community-acquired pneumonia: Utility and clinical impact on the reported etiology. J. Infect. chemother. 10: ) : ) : Vol. 19 No

8 CT 83 17) Low, I. E., S. M. Zimkus Reduced nicotinamide adenine dinucleotide oxidase activity and H 2 O 2 formation of Mycoplasma pneumoniae. J.Bacteriol. 116: ) Chu, H. W., S. Jeyaseelan, J. G. Rino, et al TLR2 signaling is critical for Mycoplasma pneumoniae-induced airway mucin expression. J. Immunol. 174: ) Shimizu, T., Y. Kida, K. Kuwano, Triacylated lipoproteins derived from Mycoplasma pneumoniae activate nuclear factor-kappab through toll-like receptors 1 and 2. Immunology 121: ) Wu, Q., R. J. Martin, S. Lafasto, et al Toll-like receptor 2 down-regulation in established mouse allergic lungs contributes to decreased mycoplasma clearance. Am. J. Respir. Crit. Care Med. 177: ) Tanaka, N., T. Matsumoto, T. Kuramitsu, et al High resolution CT findings in community-acquired pneumonia. J. Comput. Assist. Tomogr. 20: ) Lee, I., T. S. Kim, H. K. Yoon Mycoplasma pneumoniae pneumonia: CT features in 16 patients. Eur. Radiol. 16: ) Sakai, F., H. Tokuda, H. Goto, et al Computed tomographic features of Legionella pneumophila pneumonia in 38 cases. J. Comput. Assist. Tomogr. 31: Understanding of Community-acquired Pneumonia on the basis of chest computed tomography imaging Hirotsugu Ohkubo, Yuki Togashi, Yuta Kono, Yasuhiro Setoguchi First Department of Internal Medicine, Tokyo Medical University, Nishi-shinjuku, Shinjuku-ku, Tokyo , Japan Computed tomographic (CT) scans are now working in many general hospitals in Japan. Most of the Japanese clinicians can use CT scans as one of the useful tool of the examination of community-acquired pneumonia. Chest CT imaging plays an important role in the accurate interpretation of pulmonary anatomy and pathology. Mycoplasma pneumoniae pneumonia and Chlamydophila pneumoniae pneumonia demonstrate centrilobular or acinar shadows, and thickening of bronchivascular bundles on CT imaging. Characteristic findings of Legionella pneumophila pneumonia on CT are sharply demarcated peribronchovascular foci of consolidation intermingled with ground glass opacity. It is possible to estimate the pathogenic bacteria, if there are characteristic features on CT imaging on the basis of clinical information. Vol. 19 No