新型冠状病毒肺炎儿童高分辨率CT表现

目的 探讨儿童新型冠状病毒肺炎(COVID-19)患者高分辨率CT(HRCT)表现。方法 回顾性分析2020年1月25日至2月5日华中科技大学同济医学院附属武汉儿童医院22例经临床及核酸检测确诊为COVID-19患儿的胸部HRCT表现。其中男12例,女10例,年龄2个月~14岁,中位年龄4岁,5岁以下患儿14例。由2名放射科医师共同观察肺部病变分布、形态、密度等特征及有无肺门、纵隔淋巴结肿大及胸膜改变。结果 22例患儿中,3例(3/22)肺部CT正常,19例(19/22)肺部HRCT见病灶浸润,其中单侧肺病变7例,双侧肺病变12例。HRCT表现为:磨玻璃影6例,其中淡磨玻璃影4例、典型铺路石征磨玻璃影2例;4例呈肺实变改变,表现为局限性条索影、斑片状高密度影;6例表现为实变影与磨玻璃影共存,呈斑片状致密影夹杂周围磨玻璃影改变,其中1例呈右侧白肺表现;3例呈类支气管肺炎改变,表现为肺叶内散在点状或斑片状密度不均高密度影。下叶病灶较上叶为重,肺外后带较肺尖部、中央区多见。全部患儿均未见肺门淋巴结增大和胸腔积液,1例见叶间胸膜增厚。结论 儿童COVID-19的HRCT表现多样化,需结合流行病学资料、临床表现及实验室检测综合判断,但肺部CT表现可作为临床早期诊断和防控干预的重要依据。

High resolution CT features of COVID-19 in children

Objective To investigate the high resolution CT(HRCT)features of COVID-19 in children.Methods A retrospective analysis was performed on the chest HRCT findings of 22 children who were diagnosed as COVID-19 by clinical and nucleic acid testing in Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 25 to February 5,2020.There were 12 boys and 10 girls,aged from 2 months to 14 years old,with a median age of 4 years,and 14 patients were under 5 years old.The characteristics of lung lesions on HRCT such as distribution,shape,density and so on and whether there were hilar and mediastinal lymph node enlargement and pleural changes were evaluated by 2 radiologists.Results In all of the 22 patients,the chest CT manifestations were normal in 3 patients(3/22),meanwhile the lung involvement of the lesion was found in 19 patients(19/22).Among them,7 patients had unilateral lung involvement,and 12 patients had bilateral involvement.The HRCT manifestations were as follows.The HRCT showed the ground glass opacity(GGO)in 6 patients,including 4 cases with light opacity and 2 with typical crazy paving sign.Four patients had lung consolidation,with local fibrous stripes and patchy hyperdensity.Six patients had mixed GGO,including 1 case with right white lung.The bronchopneumonia-like changes were seen in 3 cases with scattered spot-like or mixed patchy.The lesions in the lower lobe were more serious than those in the upper lobe,and the lesions in the lateroposterior zone of the lung were more common than those in the apical and central area of the lung.No enlarged lymph nodes and pleural effusion were seen in all patients,but 1 case had thickened interlobar pleura.Conclusions The HRCT manifestations of COVID-19 in children are varied,and the comprehensive assessment need to be made in combination with epidemiological data,clinical manifestations and laboratory tests.However,the chest HRCT plays an important role in early diagnosis,prevention and management of COVID-19.