作　　者： ; ; ; ; ; ;

机构地区： 广州市胸科医院

出　　处： 《新发传染病电子杂志》 2019年第4期252-256,共5页

摘　　要： 婴幼儿(3岁以下)感染结核分枝杆菌罹患肺结核后,因其免疫器官发育尚未成熟,极易血行播散,甚至导致结核性脑膜炎而致残致死,必须获得准确、及时诊断。但是,患者不能清楚表达疾病症状或症状不典型、难能取得合格病原学检测样本、免疫功能不健全导致PPD反应性低下等为临床诊疗带来了诸多困难。因此,具有高密度分辨率及高图像清晰度的CT影像诊断就显得至关重要。综观目前人们的认知积累以及我们的实践经验,婴幼儿肺结核具有以下胸部CT影像特点:①原发病灶呈现结节型、炎症型、肿块型、间质型等多种形态而且分布广泛,受累4个或4个以上肺叶多见,尤以右下肺为著;②90%以上患者合并肺门纵隔淋巴结肿大,主要分布在右上气管旁(2R)、右下气管旁(4R)、主动脉弓下(5区)、隆突下区(7区)、下纵膈(8区)及右肺门(10R),肿大淋巴结平扫以中等密度为主,内出现钙化者超过50%;③约半数病例表现为腋窝淋巴结肿大,左侧腋窝出现比例高于右侧;④约10%的病例因急性、亚急性或慢性播散而显示粟粒性病灶或小结节影。结合头部MR则可见多于25%的患者合并颅内结核;⑤超过1/4的患者出现病灶旁气肿,约6%的患者可见气管支气管病变。这些特征性的胸部影像改变对婴幼儿肺结核的诊断具有较好的价值。 Mycobacterium tuberculosis in children with pulmonary tuberculosis under three years of age, of which immune organs are not mature,most likly spreads among blood circulation pathway, even lead to disabiling or lethal tuberculous meningitis. So it is essential that pulmonary tuberculosis of these children are diagnosed accurately and early. But these factors,including vague chief complicated with sympotoms or atypical sympotoms,collection of qualified sample and low reactivity caused by immature immune function,have made serious trouble for clinical diagnosis and treatment. Therefore CT imaging diagnosis for pulmonary tuberculosisin childre nunder three years of age is extremely important because CT imagines have high density resolution and image clarity. Based on achievements so far and our practical experience, characteristics of chest CT imagines of pulmonary tuberculosisin children under three years of age may be summarized as following:①nodular, inflammatory, mass, interstitial and other forms shadows scattered in four or more lobes, especially at the lower.②enlarged hilar and mediastinal Lymph node of moderately dense shadow among over 90% of cases and calcified lesion among over 50% cases,mainly located at the upper right tracheal (2R), lower right tracheal (4R), aortic arch (5 area), subcarinal (7 area), lower mediastinum (8 area) and right hilar (10R).③ axillary lymph node enlargement more common on the left side.④ miliary lesions or miliary nodules due to acute, subacute or chronic dissemination in about 10% of cases. more than 25% presented intracranial tuberculosis in head MR.⑤emphysema next to the lesion and tracheobronchial lesion more than one quarter or about 6% respectively. These characteristics of chest CT images are very useful to help diagnosis of tuberculosis in children under three years of age.

关 键 词： 结核 肺 儿童 体层摄影术 线计算机

领　　域： []