3岁以内婴幼儿肺结核CT诊断

CT findings of pulmonary tuberculosis in children under three years of age

目的:探讨3岁以内婴幼儿肺结核CT表现。方法:回顾性分析31例婴幼儿肺结核患者的CT资料,将影像表现分为干、湿2种病变类型和9种病变形式,统计各种病变的发生率。结果:湿型27例(87.0%),干型4例(13%)。肺门、纵隔淋巴结肿大27例(87.0%),其中左肺门13例,右肺门5例,双侧并纵隔9例,钙化、环状强化(鬼影样淋巴结)各4例。实变灶16例(51.6%),左肺8例,其中左上肺7例,左下肺1例;右肺6例,其中右上肺3例,右中下肺3例;双侧2例;膨出征8例,鬼影征2例,空洞左上肺、右下肺各1例。弥漫结节灶、粟粒结节及斑索高密度灶分别为11例、5例和24例,树芽征5例。支气管狭窄及气体潴留总计14例(45.2%),支气管狭窄合并气体潴留者8例;左上侧7例(50%,7/14),右侧6例,其中右上、中、下分别为1、2、3例;双下肺2例。毛磨玻璃密度灶12例(38.7%),其中双下肺10例,上肺2例。组合病灶中淋巴结肿大合并网格灶23例(芽生土豆征)(74.2%,23/31),淋巴结肿大合并肺实变15例(48.4%),淋巴结肿大合并肺内结节12例(38.7%),淋巴结肿大合并毛磨玻璃密度灶11例(35.5%);1例系统病变,累及肝脏、腹膜后淋巴结。无胸膜增厚、胸膜腔积液病例。结论:小儿结核CT影像仍有一定特点,主要以淋巴结肿大、实变和气道狭窄为主,上肺多见,多种病变形式、多发叶段病变共存。

Objective：To study the CT appearences of pulmonary tuberculosis in children under three years of age.Methods：CT data of thirty-one cases of clinically or laboratory confirmed tuberculosis in children under the age of three years were retrospectively analyzed.The imaging findings were divided into two types（dry type and wet type） and nine forms,the incidence of various types and forms of lesions was calculated.Results：There were 27 cases（87.0%） of wet type and 4 cases（13%） of dry type.Hilar or mediastinal lymph node enlargement was observed in 27 cases（left side 13 cases,right side 5 cases,bilateral 9 cases）;calcification and ring-like enhancement was seen in 4 cases each.There were pulmonary parenchymal lesions in 16 cases（51.6%）,from which 8 cases at left side（left upper 7 cases and left lower 1 case） and 6 cases at right side（right upper and lower 3 cases each）.Bilateral lesions were observed in 2 cases.Bulging sign was seen in 8 cases and ghost sign in 2 cases.Cavity was seen in left upper and right lower lung field each one case.Diffuse nodular lesions,miliary lesions and patchy lesions were observed in 11,5 and 24 cases respectively.Tree-bud sign was observed in 5 cases.Bronchial stenosis with air retention was present in 14 cases.Ground glass appearance was observed in 12 cases（38.7%）（bilateral lower field 10 cases and bilateral uper field 2 cases）.Combined lymph-adenopathy and parenchymal net-like lesions were observed in 23 cases（74.2%）.Lymphadenopathy with consolidation was seen in 15 cases,lymphadenopathy with pulmonary nodules was seen in 12 cases,lynphadenopathy with ground-glass lesions in 11 cases.Involvement of liver and retrtoperitoneal lymph node was observed in one case.No pleural thickenng and pleural effusion was observed.Conclusion：Pulmonary tuberculosis in Children has certain characteristics,these re mainly lymph node enlargement,pulmonary consolidation and airway stenosis,mainly at upper lung field with varying forms and multiple lesions in pulmonary lobes and segments.