多排螺旋CT在气管、支气管异物临床诊断中的价值

目的 探讨多排螺旋CT(MDCT)在小儿气管、支气管异物临床诊断中的价值.方法 回顾性分析临床高度怀疑气管、支气管异物且行MDCT扫描并行支气管镜检查的97例患儿的临床及MDCT表现.MDCT重建方法采用多平面重建(MPR)、CT仿真支气管镜(CTVB)、表面遮盖 (SSD)、最小密度投影(MinIP)等技术重建.结果 气管、支气管异物患儿大多数临床症状不典型,以喘息、咳嗽及肺部某一部位反复感染为常见症状.97例患儿中,异物种类以不透光植物性异物为主,且大多数位于肺叶、段以下支气管内及左、右主支气管.其中89例通过各种MDCT重建方式直接显示异物,并发现由异物所引起的阻塞性肺炎、肺气肿、肺不张及纵隔气肿等各类并发症.4例未显示异物,仅显示一侧阻塞性肺气肿及肺内斑片状炎症,支气管镜探查取出异物.4例经支气管镜检查,在MDCT提示异物的支气管管腔内未发现异物,其中2例为黏稠痰栓,此4例经抗炎治疗后肺部炎症及临床症状消失.在CT影像结果指导下行支气管镜检查,93例钳取到异物.MDCT诊断小儿气管、支气管异物准确性为95.9%.结论 MDCT在小儿气管、支气管异物诊断中有实用价值,但在使用时要密切结合临床病史及体征.

Diagnostic Value of Multidetector Spiral CT for Foreign Bodies in Trachea and Bronchus of Children

Objective To explore the diagnostic value of multidetector spiral CT(MDCT) for foreign bodies in trachea and bronchus of children. Methods The clinical and MDCT manifestations of 97 children with highly suspected tracheobronchial foreign body were analyzed retrospectively.MDCT scan and bronchoscopy were performed in all the patients,and the post-processing reconstruction included multiple planar reconstruction(MPR),CT virtual bronchoscopy(CTVB),shaded surface display(SSD) and minimum intensity projection(MinIP). Results The clinical symptoms of tracheobronchial foreign bodies in children were generally atypical,and the common symptoms were various degrees of wheezing,coughing and recurrent lung infection.Of all the 97 cases,the foreign bodies were mainly opaque plant ones,and mostly were located in the bronchus lobaris and below the segmental bronchus,the left or right main bronchus.In 89 cases,foreign bodies were found directly by MDCT reconstruction,and the complications such as obstructive pneumonia,emphysema,atelectasis and mediastinal emphysema caused by foreign bodies were also shown.In 4 cases,MDCT only showed emphysema on one side and patchy pulmonary inflammation,while the foreign bodies which were not found by MDCT were removed by bronchoscopy.In another 4 cases,foreign bodies in the bronchial lumen showed on MDCT disappeared under bronchoscopy,among which two turned to be thick sputum.After anti-inflammatory treatment,lung inflammation and clinical symptoms disappeared in these patients.Bronchoscopy was performed under the guidance of CT imaging results,and the foreign bodies were removed successfully in 93 cases.The accuracy of MDCT in the diagnosis of tracheobronchial foreign body in children was 95.9%. Conclusions MDCT has great value in the diagnosis of tracheobronchial foreign body in children,but the clinical history and physical signs of the patients should also be considered.