儿童肺炎支原体肺炎与肺炎支原体合并链球菌感染肺炎的胸部CT表现及其鉴别

目的探讨肺炎支原体肺炎(MP)和肺炎支原体合并链球菌感染肺炎(MP+SP)的影像学表现差异,为临床早期鉴别单纯MP及MP+SP提供帮助。方法回顾性分析经血清学及血培养证实的23例单纯MP和23例MP+SP患儿的胸部CT图像,分别对病变分布、病变形态及合并症(如肺气肿、胸腔积液、淋巴结肿大等)进行比较及统计学分析。结果与MP+SP比较,单纯MP多表现为肺间质病变,包括支气管壁增厚、磨玻璃影、网状影及支气管血管束增厚(P<0.05);而MP+SP则以肺实变影为主,且胸腔积液量及肿大淋巴结直径均大于单纯MP患儿(P<0.05)。从病变形态上看,单纯MP的肺内阴影多为自内向外,呈扇形分布的薄片影;MP+SP则多为无分布规律的大片实变影。结论单纯MP表现为在较少肺实变基础上合并较明显的肺间质改变;而MP+SP的肺泡炎症程度较重,片状阴影密度高、范围大,但肺间质表现不突出,同时易伴有中-大量胸腔积液及淋巴结显著增大。

Chest CT manifestations and differentiation of pure mycoplasma pneumonia and mycoplasma combined withstreptococcus pneumonia in children

Objective To investigate the CT characteristics of pure mycoplasma pneumonia (MP) and mycoplasma combined streptococcus pneumonia (MP+SP) in children, in order to provide information for early differential diagnosis of MP and MP+SP. Methods CT images of 23 children with MP and 23 children with MP+SP proved by serology and hemoculture were reviewed retrospectively. The CT findings of lesion distribution and density, ground-glass opacity (GGO), reticular, bronchovascular bundle thickening, bronchial wall thickening, pleural effusion, lymphadenopathy, and pulmonary emphysema were compared between MP and MP+SP. Results Compared to MP+SP patients, the incidence of GGO, bronchovascular bundle thickening, and bronchial wall thickening were higher in MP patients (all P<0.05), whereas the consolidation density, the amount of pleural effusion and size of lymphadenopathy were more larger in MP+SP group than in MP group (P<0.05). In term of lesion distribution and density, the pure MP commonly appeared as thin sector shadow, from inside to outside, while the MP+SP patients appeared frequently as consolidation without regular distribution. Conclusion MP mainly manifests as apparent changes of interstitial lung on the basis of a certain degree of changes in lung parenchyma. However, more severe pulmonary alveolitis can be observed accompanied with a larger extent of inflammation induced condensed shadow in a shape of flake and less infiltration of interstitial lung in MP+SP patients. MP+SP also manifests as a large amount of pleural effusion and severe lymph node enlargement.