儿童肺血管疾病的影像学诊断

Imaging diagnosis of pulmonary vascular diseases in children

肺血管疾病是一组累及包括各级肺动、静脉及肺毛细血管在内的肺循环疾病,其致病因素各异,病理改变多样。儿童与成人肺血管疾病从致病因素、发病机制、病理生理学,临床表现及预后等方面均存在较大差异。儿童肺血管性疾病包括以下几大类别:(1)先天性肺血管病变,包括各级别的肺动、静脉畸形、肺毛细血管发育异常、气管支气管畸形伴肺血管畸形、血管淋巴异常等;(2)肺血管栓塞性病变,包括炎症性栓塞,肿瘤性栓塞;(3)肺血管炎性病变;(4)肺动脉高压性病变;(5)肺部血管源性肿瘤。儿童常见肺血管疾病常用的影像学检查方法有胸部X线平片、超声心动图、胸部CT增强扫描、肺血管造影检查、核医学肺通气/灌注显像等。该文对上述儿童常见肺血管疾病影像学检查方法的选择及影像学诊断要点进行概述。

Pulmonary vascular diseases are a group of diseases involving all levels of pulmonary arteries,veins and pulmonary capillaries of pulmonary circulation.It has different pathogenic factors and pathological characteristics.There are significant differences between children’s and adults’pulmonary vascular diseases in terms of pathogenic factors,pathogenesis,pathophysiology,clinical manifestations and prognosis.Pediatric pulmonary vascular diseases include:1.congenital pulmonary vascular malformation,including pulmonary arteriovenous malformation,pulmonary capillary dysplasia,tracheobronchial malformation with pulmonary vascular malformation and vascular lymphangiopathy,etc;2.pulmonary embolism including inflammatory embolism and tumor embolism;3.pulmonary vasculitis;4.pulmonary hypertension;5.pulmonary angiogenic tumor.The common imaging examination methods of pediatric pulmonary vascular diseases are chest X-ray plain film,ultrasonic echocardiography,chest CT enhanced scan,pulmonary angiography,radionuclide ventilation and perfusion lung scan,etc.In this paper,the evaluation of imaging examinations and the key points of imaging diagnosis in the abovementioned pediatric pulmonary vascular diseases are summarized.