儿童肺结核CT影像分析

目的 探讨儿童肺结核的CT平扫及增强的影像表现特征。 方法 回顾性分析2008年7月至2011年8月在我院住院的69例结核病患儿，临床症状、PPD试验及影像学表现均符合结核病特征，经抗结核治疗后复查，患者临床症状及肺部病灶均有所好转。收集患儿的影像学资料，对其进行分析。 结果 69例患儿的CT不同影像表现为：原发性肺结核（8例）包括原发综合征（5例）和胸内淋巴结结核（3例），原发综合征表现为肺内的原发结核病灶、结核性淋巴管炎及淋巴结炎，此型与胸内淋巴结结核的CT平扫均可见纵隔、肺门及腋窝多发肿大淋巴结，增强扫描不均匀强化或淋巴结中心干酪坏死区无强化，边缘环形强化的特点。原发性血行播散性肺结核（10例）表现为两肺大小、密度、分布均匀一致的粟粒状影合并纵隔淋巴结肿大。原发性肺内浸润性结核病灶和干酪性肺炎（43例）的影像表现为2个肺叶散在分布的结节状、斑片状影，还有甚至双肺多叶多段广泛分布的结核病灶，在结节状、斑片状、大片状结核病灶的基础上形成干酪性肺炎、空洞。结核性胸膜炎（8例）可见不同程度的渗出性胸腔积液及胸膜增厚粘连等表现。 结论 CT平扫及增强对于诊断儿童肺结核，明确肺内各种病灶形态，轻微病灶、隐匿病灶、微结节及干酪性肺炎等具有一定价值，可为临床诊断提供重要依据。

Multislice spiral CT imaging manifestations of pulmonary tuberculosis in children

Objective To explore imaging characteristics of plain and enhanced CT scan for pulmonary tuberculosis in children.Methods We analyzed retrospectively imaging data from 69 children patients with pulmonary tuberculosis hospitalized in Xinjiang Uygur Autonomous Region Chest Hospital from July 2008 to August 2011.All patients were confirmed diagnosis with clinical symptoms,TST result,CT imaging and clinical symptoms improved after antituberculous treatment.Results Different CT imaging were as follows：8 cases with primary pulmonary tuberculosis including 5 cases with primary syndrome and 3 cases with tuberculosis of intrathoracic lymph nodes.Primary syndrome was composed of primary tuberculosis focus,tuberculous lymphangitis and lymphadenitis.CT plain scan showed multiple lymphadenectasis in hilum of lung and mediastinal,axillary.Meanwhile,heterogeneous enhancement or lymph node center caseous necrosis zone without enhancement,edge ring enhancement features were showed in enhanced scan imaging.The miliary nodules in size,density,distribution were uniform in two lungs and the mediastinal lymph node was enlarged in 10 cases with hematogenous disseminated pulmonary tuberculosis.The imaging of infiltrative focus and caseous pneumonia presented scattered nodules and patchy shadow in two or more lobes in 43 cases.Caseous pneumonia or cavitation formation were based on the nodular,patchy,large patchy foci of tuberculosis.Eight cases with tuberculous pleurisy were presented with pleural effusion and pleural thickening.Conclusion Plain and enhanced CT have a certain value in the diagnosis of childhood pulmonary tuberculosis and in definition of lung lesions clearly various morphological,mild lesions,occult lesions,micro nodules and caseous pneumonia.It also provide strong basis for diagnosis.