儿童SARS的胸部X线临床观察

目的　探讨儿童SARS的临床及胸部平片表现特点。方法　回顾 18例按卫生部诊断标准临床诊断为SARS儿童的接触史、主要症状 ,实验室检查结果和胸片表现 ,对照国内外文献进行分析。 18例均有接触史 ,14例为密切接触。主要临床表现为发热、咳嗽、外周血白细胞低 ,其中 5例 <5× 10 9/L ,15例淋巴细胞低。结果　主要胸片X线表现 :( 1) 13例见肺内片状及斑片状实质浸润阴影 ;( 2 ) 3例为类圆形病变 ,边界较清楚 ;( 3 ) 2例磨玻璃样改变 ;( 4 )单侧单发病变多见 ( 10例 ) ,内带较外带略多见 ;( 5)网格状及条点状改变少见 ,未见纵隔、肺门淋巴结肿大及胸腔积液 ;( 6)短时间内病灶变化不如成人快 ,但个别病例病灶呈游走性 ,吸收好转平均 19d。绝大多数病例无后遗改变。结论　儿童SARS的临床表现较成人轻 ,多数有明确接触史 ,X线表现以一侧单发实质浸润病变多见 ,可完全吸收不留后遗症。诊断时需注意与支原体肺炎、腺病毒性肺炎鉴别。

Features of clinical and radiographic appearances of SARS in children

Objective To evaluate the features of clinical and radiographic appearances of SARS in children. Methods The chest films obtained at clinical presentation and during treatment in 18 children with confirmed SARS were retrospectively evaluated. Results The main X-ray manifestations included: (1) air-space opacity in 13/18; (2) round lesion with clear margin in 3/18; (3) ground-glass lesions in 2/18; (4) unilateral and single focal involvement was more common in children than in adults (5) no reticular shadow, lymphanopathy or pleural effusion was demonstrated; (6) radiographic changes of foci was not as rapid in children as in adults. The lesions migrated in 1 case. The average absorption time of the lesions was 19 days, and most of them had no remnant. Conclusion Compare with that in adults, the clinical manifestation was not so severe in children with SARS, and most of the infected children had clear contact history. Chest X-ray appearance in affected children mainly showed unilateral involvement of the lungs with chiefly air-space infiltrates. Remnant lesion of lung is rare in children. Differential diagnosis of SARS in children includes mycoplasma pneumonia or adenovirus pneumonia.