儿童球形肺炎的CT影像学诊断
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摘要
目的:探讨儿童球形肺炎的CT影像学特征。方法:搜集2016年1月-2017年7月在本科室进行胸部CT平扫及增强检查,并在首次检查后2～4周行胸部CT平扫复查,确诊为球形肺炎的21例患儿的CT影像学资料。结果:21例患儿共发现球形病灶25处,CT平扫时病灶中心区呈高密度影,中间带见环形气泡影,外周带呈环形稍高密度影,向外周延伸,密度逐渐减低,CT增强时病灶中心区动脉期明显强化,中间带未见强化,外周带轻度强化,病灶内及病灶边缘可见强化血管影,球形病灶与肺门间血管稍增粗,复查CT显示25处病灶中20处完全消失,2处呈絮状稍高密度影,3处为仅剩中心区的小斑片状稍高密度影。结论:儿童肺内球形病灶中"气泡手串征"高度提示球形肺炎的可能。
Objective:The purpose of this study was to explore the CT features of spherical pneumonia in children.Methods:The CT imaging features of 21 cases with spherical pneumonia between January 2016 and July 2017 in our department were retrospectively analyzed.All cases had both plain and contrast-enhanced CT scan initially before any treatment,and had CT plain scan as follow-up2 to 4 weeks after the first examination.Results:25 spherical lesions were found in 21 cases,CT plain scan showed the central area of the lesion was of high density.The ring-like air bubble was seen in the center zone,and a slightly higher density shadow was showed in the peripheral zone.Density was gradually decreased along with it extending outward.Enhanced CT scan showed the central area of lesions was obviously enhanced on arterial phase,the center zone was not enhanced,the peripheral zone was mildly enhanced.Enhanced vascular structures were observed in the lesion and its marginal area.The vascular between the lesion and hilum was slightly thickened.In 21 patients 2～4 weeks after treatment with chest CT scan showed that 20 of the 25 lesions completely disappeared.Two cases showed as flocculent exudative lesion with slightly high density.Three cases remained as patchy lesions with slightly high density in the central area.Conclusion:The " bubble hand string sign",found in the pulmonary spherical lesions in children,highly indicates the possibility of spherical pneumonia.
Objective:The purpose of this study was to explore the CT features of spherical pneumonia in children.Methods:The CT imaging features of 21 cases with spherical pneumonia between January 2016 and July 2017 in our department were retrospectively analyzed.All cases had both plain and contrast-enhanced CT scan initially before any treatment,and had CT plain scan as follow-up2 to 4 weeks after the first examination.Results:25 spherical lesions were found in 21 cases,CT plain scan showed the central area of the lesion was of high density.The ring-like air bubble was seen in the center zone,and a slightly higher density shadow was showed in the peripheral zone.Density was gradually decreased along with it extending outward.Enhanced CT scan showed the central area of lesions was obviously enhanced on arterial phase,the center zone was not enhanced,the peripheral zone was mildly enhanced.Enhanced vascular structures were observed in the lesion and its marginal area.The vascular between the lesion and hilum was slightly thickened.In 21 patients 2～4 weeks after treatment with chest CT scan showed that 20 of the 25 lesions completely disappeared.Two cases showed as flocculent exudative lesion with slightly high density.Three cases remained as patchy lesions with slightly high density in the central area.Conclusion:The " bubble hand string sign",found in the pulmonary spherical lesions in children,highly indicates the possibility of spherical pneumonia.
引文
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[15]陈容风,伍筱梅,邓宇,等.肺错构瘤的多层螺旋CT诊断[J].实用医学影像杂志,2011,12(4):208-210,220.
[16]吴维,张进华,万维佳,等.能谱CT诊断孤立性肺结节/肿块的初步研究[J].放射学实践,2014,29(9):998-1002.
[2]宋春燕,王雯.球形肺炎影像学诊断(附56例分析)[J].医学影像学杂志,2009,19(5):539-540.
[3]张海宁,张庆华,吴艳,等.19例球形肺炎的病原学分析[J].临床肺科杂志,2015,20(8):1526-1527.
[4]Cilla G,O1ate E,Perez-Yarza EG,et al.Viruses in community-acquired pneumonia in children aged less than 3years old:high rate Of viral coinfection[J].Med Virol,2008,80(10):1843-1849.
[5]中华医学会呼吸病学分会.社区获得性肺炎诊断和治疗指南[J].中华结核和呼吸杂志,2006,29(10):651-655.
[6]徐岩,马大庆.免疫正常人群肺炎的影像表现[J].中华放射学杂志,2013,47(11):1054-1056.
[7]李子江.CT诊断球形肺炎[J].实用放射学杂志,2000,16(4):215.
[8]蔡祖龙,郝敬明,郭天舜,等.球形肺炎的CT诊断[J].中华发射学杂志,1996,30(5):528.
[9]冯亮,陈君坤,卢光明,等.CT读片指南[M].南京:江苏科学出版社,2000:217.
[10]李晓红,杨洪巍,许村民,等.球形肺炎的螺旋CT表现[J].影像诊断与介入放射学,2008,17(2):81-83.
[11]刘伟.肺孤立性炎性结节的CT诊断[J].实用放射学杂志,2003,19(8):702.
[12]冯国强.肺炎性假瘤的CT诊断[J].吉林医学,2013,34(13):2505-2506.
[13]王华斌,李苏建,卢光明.多层螺旋CT评估孤立性肺结节的临床研究进展[J].放射学实践,2010,25(1):105-108.
[14]周永生,张承惠,黄向名,等.直径小于3cm肺结核球和周围型肺癌的CT诊断[J].中国临床医学影像杂志,2003,14(2):91-93.
[15]陈容风,伍筱梅,邓宇,等.肺错构瘤的多层螺旋CT诊断[J].实用医学影像杂志,2011,12(4):208-210,220.
[16]吴维,张进华,万维佳,等.能谱CT诊断孤立性肺结节/肿块的初步研究[J].放射学实践,2014,29(9):998-1002.