儿童肺结核的临床和X线特点：附265例病例分析

我院自1981～87年收治265例儿童肺结核病人。原发型肺结核占83.4%。其中以气管-支气管淋巴结肿大多见。年龄越小症状越不典型。87.9%病人以发热为主要症状。OT 或PPD 试验83.3%呈强阳性反应。本文对儿童肺结核早期诊断从临床角度和X 线提出要点。对治疗的疗程提出看法。     

小儿气管、支气管异物胸部X线表现的临床研究

气管、支气管异物属于急重症，如果不及时诊断和手术，就有生命危险。尽管人们已开始应用MRI、冠状位CT扫描等技术探讨了其在诊断气管异物中的价值。但传统的胸部X线及透视下观察纵隔摆动的检查方法因诊断迅速、费用低廉，仍为诊断呼吸道异物首选辅助检查。我们分析了220例气管、支气管异物患儿胸部X线表现特点，并探讨其在确定气管、支气管异物位置和判断手术效果中的作用。     

五例严重急性呼吸综合征患儿的临床和胸部X线表现特点

目的　探讨儿童SARS的临床和胸部X线表现特点。方法　分析 5例经流行病学、临床、实验室和放射学检查确诊的SARS患儿临床资料和胸部X线表现。结果　 5例SARS患儿中 ,3例有明确的SARS密切接触史。发热为首发症状 ,4例体温在 3 8℃以上 ,最高 40℃ ,持续时间 4～ 7d ,平均 5.6d。实验室检查 :SARS病毒RNA特异性片段RT PCR检测阳性 1例 ;SARS病毒抗体IgM和IgG双项阳性 1例 ,SARS病毒抗体IgG单项阳性 2例 ,IgM单项阳性 1例。肺炎支原体 ,肺炎衣原体IgG、IgM及血培养等均阴性。胸部X线表现 :单侧肺部片状影或斑片状阴影 4例 ,其中磨玻璃样阴影及游走性改变者 1例 ;肺内间质性改变者 1例 ,表现为不规则网格状及索条状影 ;肺部病灶吸收时间最短 7d ,最长 3 3d ,平均 ( 15± 6)d ,无 1例出现肺部纤维化改变。 5例全部治愈出院。结论　儿童SARS与成人相比 ,其临床症状和体征相对比较轻。胸部X线表现以肺的单侧片状阴影改变为主 ,亦可见磨玻璃样影和病灶上下游走性改变     

小儿亚临床型肺吸虫病胸部X线征象(附41例报告)

本文观察了41例小儿亚临床型肺吸虫病的胸部X 线征象.发现正常者9例(占21.7%),异常者32例(占78.3%).其中以肺实质改变为主,肺纹理及胸膜改变次之.但无卫氏肺吸虫病最为常见的囊肿阴影或结节阴影.其原因可能与肺吸虫在宿主中没能找到适宜的寄生环境,很少在肺部形成虫囊有关.由于肺吸虫在胸部所致病变的广泛性及病理变化的多样性,形成了胸部X 线表现的复杂性.提示胸部X 线征象在小儿亚临床型肺吸虫病诊断及鉴别诊断上均具有重要意义.     

不同程度支气管肺发育不良早产儿的临床及影像学特点

目的　探讨不同程度支气管肺发育不良(BPD)早产儿的临床及影像学特点。方法　对59例胎龄<32周BPD 早产儿的临床及影像学特点进行前瞻性研究。59例早产儿中包括轻度BPD 37例, 中/重度BPD 22例, 比较不同程度BPD患儿的临床及影像学表现。结果　中/重度BPD组患儿机械通气、氧疗、抗生素、静脉营养等应用时间及住院时间长于轻度BPD组(P<0.05), 院内感染发生率、红细胞输注次数高于轻度BPD组(P<0.05)。轻度BPD组呼吸窘迫综合征(RDS)Ⅰ级(生后1 d)、肺透亮度减低(生后4~10 d、生后28 d及以上)等X线改变比例较中/重度BPD组高(P<0.05); 中/重度BPD组BPD Ⅲ期改变(生后4~10 d)、BPD Ⅳ期改变(生后28 d及以上)等比例较轻度BPD组高(P<0.05)。结论 呼吸机、氧疗、抗生素等应用时间及院内感染发生率与BPD严重程度相关。BPD程度越重的患儿, 静脉营养时间越长, 输注红细胞次数越多, BPD影像学改变更典型。BPD影像学检查对BPD的严重程度有一定的预测作用。     

数字X线成像与多排螺旋CT对小儿呼吸道透X线异物检出效果的比较

目的 探讨小儿呼吸道透X线异物的临床特点,比较数字X线成像(DR)与16排螺旋CT对其的检出效果.方法 收集本院2007年1月-2011年1月收治的50例经纤维支气管镜检查证实为呼吸道异物患儿的临床资料.男28例,女22例;年龄10个月～11岁.有明确异物吸入史31例,可疑异物吸入史并伴相应症状3例.患儿均经DR行胸部正侧位检查,以及16排螺旋CT检查和CT呼吸道三维重建.结果 31例患儿首诊有异物吸入史,均有不同程度刺激性呛咳、发热、喘鸣等.体格检查发现呼吸音减弱32例,发绀21例,三凹征19例.50例患儿胸部DR均不能直接发现透X线异物;16排螺旋CT三维重建模拟支气管镜可直接发现呼吸道透X线异物.异物附着在管壁上或嵌顿于管腔内.胸壁双边影15例;节段性肺不张12例;纵隔双边影或纵隔移位8例;支气管扩张18例;肺部感染8例;肺野静止征16例.CT的诊断阳性符合率为96％,DR为62％.结论 16排螺旋CT对小儿呼吸道透X线异物的诊断及手术定位具有重要价值,与DR相比具有明显的优势.     

肺部超声是否能取代胸部X线检查？一项前瞻性多中心研究

目的分析肺部超声和胸部X线在新生儿肺部疾病诊断中的准确性。方法前瞻性地纳入2019年6月至2020年4月全国12个新生儿重症监护病房需要进行胸部X线检查以诊断肺部疾病的新生儿。每例新生儿在接受胸部X线检查后的2 h内接受肺部超声检查。所有的胸部X线和肺部超声图像分别在不了解临床病史的情况下由放射科医师和超声医师独立判读。当胸部X线和肺部超声结果存在分歧时, 由两名有经验的医师组成的专家组根据临床病史、胸部X线和肺部超声图像做出最终诊断。结果共有1 100例新生儿参与了本研究。胸部X线和肺部超声之间的诊断一致性较差(Cohen′s kappa系数=0.347)。肺部超声在诊断湿肺(曲线下面积0.778, 95%CI 0.753～0.803)时诊断价值明显优于胸部X线(曲线下面积0.513, 95%CI 0.483～0.543)(P<0.001)。肺部超声和胸部X线对新生儿呼吸窘迫综合征、肺炎、胎粪吸入综合征和新生儿肺不张的诊断准确性相似。结论肺部超声做为一种低成本、简单、无辐射的辅助检查方法, 诊断准确率接近或优于胸部X线, 可替代胸部X线诊断新生儿肺部疾病。需要注意的是, 胸部X...     

X线腕片骨皮质分层对诊断佝偻病的价值

X线腕片对婴幼儿佝偻病诊断具有确定性意义，为了解骨皮质分层是否可作为诊断佝俊病的征象，我们对91例佝楼病患儿在腕关节X线正位片进行分析。发现23例出现骨皮质分层。现报告如下。对氛与方法一、对象0～3岁婴幼儿323例，男175例，女148例，均经摄在腕关节正位X线片，查血生化（钙、磷、AKP），询问病史，检查佝楼病体征。诊断佝楼病91例（28．2％），其中只49例，女42例。二、方法均摄左腕关节正位片，三、诊断标准按卫生部1986年颁布的“婴幼儿佝楼病防治方案”诊断‘’‘。结果一、正常儿与佝楼病儿在腕关节x片骨皮质分层比较见表儿…     

Thoracic actinomycosis in an adolescent mimicking chest wall tumor or pulmonary tuberculosis

Actinomycosis is a rare disease in children and young adolescents and its thoracic manifestations accounted for a minority of all cases. We report a case of a 12-year-old boy who presented with a right anterior chest wall mass for one week together with weight loss and low grade fever for one month. His symptoms and signs as well as the results of the radiological investigations (i.e. chest X-ray and computed tomography (CT) of thorax with contrast) mimicked pulmonary tuberculosis or chest wall tumor. The definite diagnosis of actinomycosis relies on the Gram stain microscopy and culture of the chest wall lesion aspirates. An early and accurate diagnosis can prevent the patient from unnecessary invasive procedures such as open lung biopsy or thoracotomy. The mainstay of the treatment of actinomycosis remains to be a combination of abscess drainage as well as prolonged antibiotics such as penicillin. Follow-up CT scan of thorax with contrast is useful in monitoring the progress of disease recovery.     

潮气呼吸分析参数结合胸部CT在评价先天性心脏病患儿肺功能中的应用

目的 探讨潮气呼吸分析参数结合胸部CT在评价先天性心脏病患儿肺功能中的临床应用价值.方法 对44例先天性心脏病儿童进行潮气呼吸肺功能测定,并对其中28例进行胸部螺旋CT三维重建气管、支气管树成像(CTB).同时选取普通肺炎患儿64例进行潮气呼吸肺功能测定作为对照,并对其中49例进行胸部CT检查.结果 44例先天性心脏病患儿呼吸频率(RR)增快,吸气时间(TI)缩短,达峰时间比(TPTEF/TE)、到达潮气呼气峰流速时的呼气量(VPTEF)、达峰容积比(VPEF/VE)明显下降(P<0.01),呼气峰流速(PTEF)和75%潮气量时的潮气呼气流速(TEF 75)升高(P<0.05).28例先天性心脏病患儿胸部CT显示肺部感染、气道狭窄、肺气肿和肺不张,患病率明显高于对照组(P<0.05).结论 潮气呼吸参数中TPTEF/TE、VPTEF、VPTEF/VE能反映先天性心脏病阻塞性通气功能障碍,胸部CT能进一步显示通气功能障碍的原因,两种无创技术相结合,能较全面反映先天性心脏病患儿的肺功能状态.     

Chest computed tomorgraphy in infants and children An analysis of 50 patients

Chest computed tomography (CT) scans were performed in 50 pediatric patients. The techniques and inherent problems are presented. CT provides detailed anatomic information about the chest wall, mediastinum, and lungs. Pediatric chest CT is particularly valuable in the evaluation of extrapleural masses, parenchymal metastatic disease, and posterior mediastinal tumors.Presented at the Annual Meeting of the Society for Pediatric Radiology, Salt Lake City, Utah, USA, April 1980     

多项无创或低创检查联合对痰菌阴性儿童肺结核的诊断价值

目的 探讨多项无创或低创检查联合[ 肺部CT 扫描、PPD 试验、血沉（ESR）、C- 反应蛋白（CRP）] 对痰菌阴性儿童肺结核的临床诊断价值。方法 回顾性收集269 例肺结核儿童的临床资料,包括痰菌阴性161 例,痰菌阳性108 例,对两组临床特征及多项检查结果进行对比分析。结果 痰菌阴性肺结核儿童临床表现不典型;典型或相对特异的影像学征象较痰菌阳性组少;PPD 试验、ESR、CRP 在菌阴组的阳性率分别为39.1%、44.1%、56.5%,在菌阳组的阳性率分别为55.6%、79.6%、59.3%,两组比较,PPD 试验、ESR 阳性率差异有统计学意义（PP>0.05）。痰菌阴性组中有46 例行支气管镜术,40 例（87.0%）镜下发现有诊断价值的形态改变和（或）获得病原学/病理学诊断依据。结论 对于痰菌阴性儿童肺结核的诊断,联合肺部CT 扫描、PPD 试验、ESR、CRP 多项无创或低创检查可明显提高诊断率;若仍未能提供有力证据时,支气管镜术是十分重要的辅助检查手段。     

Intensive short-course chemotherapy in pulmonary tuberculosis

One hundred and twenty children with possible diagnosis of pulmonary tuberculosis were admitted in this study for evaluating the efficacy of short course chemotherapy regimens in childhood pulmonary tuberculosis and are under follow up. In only three patients smear was positive for AFB. In 74 cases culture for AFB was done of which 18 cases (24·3%) were found to be positive. Fortyone patients were put on a standard one year regimen consisting of streptomycin, isoniazide and ethambutol as a control group and seventy nine patients were put on short-course regimens, consisting of isoniazid, rifampicin and pyrizinamide. Out of these 79 patients, 39 were in a biweekly regimen consisting of isoniazid and rifampicin after initial intensive therapy with three drugs for two months. In majority of patients clinical improvement and in all patients bacteriological improvement was observed at the end of two months period. Marked radiological improvement at the end of therapy was seen in only about two-third patients. Relapse after stopping therapy occurred in one patient with associated tubercular cervical lymphadenitis.     

Interobserver variability in the detection of mediastinal and hilar lymph nodes on CT in children with suspected pulmonary tuberculosis

Background: The presence of mediastinal or hilar adenopathy is critical for the diagnosis of pulmonary TB. Interobserver variability in the detection of lymphadenopathy on CT in children affects the usefulness of CT as a gold standard. Objective: To determine the interobserver variability for the detection of hilar and mediastinal adenopathy on CT in children. Materials and methods: One hundred children with clinically suspected pulmonary TB were prospectively recruited for CT scanning of the chest. Four observers reviewed the scans independently for the presence of lymphadenopathy at predetermined sites. Overall Kappa statistic was determined for each recognised site of mediastinal and hilar lymphadenopathy. Results: Kappa statistics showed that observers only agreed moderately in their detection of lymphadenopathy. The site of best agreement was the right hilum, followed by the subcarinal, right paratracheal and precarinal locations. Observers differed most at the anterior mediastinum and left hilum. The best Kappa statistic was for the overall presence of lymphadenopathy taking all sites into account. Conclusions: Imaging techniques that are considered the gold standard for particular diseases must be validated pathologically, and if this is not possible, interobserver variability should be evaluated. CT is considered the gold standard for detecting lymphadenopathy, but we have shown only moderate agreement between readers. Readers had difficulty in distinguishing lymphadenopathy from normal thymus and were unable to distinguish normal from pathological nodes without a predetermined size threshold for abnormality. The right hilum and the sites around the carina are the most reliable for the reported presence of lymphadenopathy.     

Risk of pulmonary tuberculosis in children with congenital heart disease

Children with low-flow congenital heart lesions are reported to have an increased incidence of pulmonary tuberculosis. The aim of this study was to investigate if children with congenital heart disease have an increased incidence of pulmonary tuberculosis and to determine if patients with certain heart conditions are more susceptible to pulmonary tuberculosis than others. This retrospective study over a 6-year period showed that pulmonary tuberculosis was 2.5-fold more common in children with congenital heart disease than in normal children from the same community. Children with congenital pulmonary stenosis had a prevalence equal to those with acyanotic (ventricular and atrial septal defects) and cyanotic (transposition of the great arteries) high-flow heart lesions, whereas there were no cases of tuberculosis in children with low-flow cyanotic heart lesions such as tetralogy of Fallot. Cardiac surgery had to be postponed as a result of pulmonary tuberculosis in 7.2% of all patients in whom it was required. Over the 6-year period of the study, cardiac surgery had to be delayed in 60% of cases with pulmonary tuberculosis and congenital heart lesions so antituberculosis therapy could be completed. Physicians treating children with congenital heart lesions should maintain a high index of suspicion for the development of pulmonary tuberculosis, especially in those with acyanotic and cyanotic high-flow lesions and pulmonary stenosis.     

CT of the chest in the evaluation of idiopathic pulmonary arterial hypertension in children

Background Idiopathic pulmonary arterial hypertension (IPAH) is a rare disease in children. By definition it is a diagnosis of exclusion, and CT of the chest is primarily performed to exclude other causes. Previous studies have defined CT features suggestive of the diagnosis of IPAH, but these have all been limited to the adult population. Objective Contrast-enhanced chest CT and high-resolution CT findings in IPAH were evaluated in an attempt to define features consistently seen in children with this condition. Materials and methods The chest CT scans performed at initial presentation were reviewed in 17 children with echocardiographic or angiographic evidence of IPAH. Result There were nine boys and eight girls, ranging in age from 1 month to 17 years. The extrapulmonary findings included cardiomegaly with right-sided cardiac enlargement, which was seen in 13 children. The central pulmonary arteries were enlarged in 15 children, with peripheral enlargement in two. In six children this resulted in bronchial compression. In addition, mediastinal and hilar lymphadenopathy was noted in three children. Prominent intrapulmonary features included a peripheral vasculopathy, with enlarged tortuous vessels, seen in eight children. Ill-defined ground-glass centrilobular opacities were also noted in eight children, representing the most common parenchymal abnormality. Other findings included septal lines in five, diffuse ground-glass opacification in four and focal hyperlucent zones in three. Mosaic attenuation was seen in one child. Conclusion A variety of imaging findings are identified in IPAH. Features particularly consistent with the diagnosis include peripheral vasculopathy and centrilobular opacities in the setting of cardiomegaly and central pulmonary arterial enlargement.     

Prevention of tuberculosis in infancy

A prospective study was conducted on 185 consecutive hospitalized cases of tuberculosis below the age of one year, and 41 mothers comprised half of the 83 contacts detected. Maternal and infant infection was analyzed to determine whether the disease could have been prevented under the existing medico-socio-economic conditions. Most mothers had delayed diagnosis and extensive disease. Earlier imperfect courses of chemotherapy were not uncommon. Ten mothers were sputum-positive for acid-fast bacilli. The concerned medical personnel failed to give proper advice with respect to chemoprophylaxis and surveillance of infants. Majority of infants had progressive pulmonary and disseminated disease although, 41% of them were BCG vaccinated. A practical strategy in the Indian context for the management of tuberculosis in the motherinfant pair is outlined.     

Chest Radiography and the Evaluation of the Neonate for Congenital Heart Disease

We assessed the utility of the chest film as a screening tool for term and preterm neonates with suspected structural heart disease. Three independent observers, blinded to patient diagnosis, retrospectively evaluated the initial chest film for each of 128 consecutive neonates with suspected heart disease (gestational age, 23–42 weeks; birth weight, 500–4621 g) who had undergone both chest radiography and echocardiography. These evaluations were subsequently compared with the results of the respective echocardiograms, read by board-certified pediatric cardiologists blinded to the chest film and chest film interpretation. Kappa statistics demonstrated moderate correlation (0.42–0.48) among different observers in their interpretation of the chest films but poor correlation (0.15–0.34) between chest radiography and echocardiography. The chest film had a low sensitivity for structural heart disease (26–59%), with a negative predictive value of 46–52%. Among neonates less than 2 kg or younger than 35 weeks of gestation, the chest film had still lower sensitivity for detecting heart disease. Despite agreement among observers in chest film interpretation, the chest film does not function as a screening test for neonates with suspected heart disease, particularly in small or premature neonates. In neonates with suspected heart disease, echocardiography should be considered, even in patients with chest films that do not suggest congenital heart disease.