儿童腹型过敏性紫癜的MSCT诊断及鉴别诊断

Multi-slice spiral CT in the diagnosis and differential diagnosis of abdominal type anaphylactoid purpura in children

目的:分析儿童腹型过敏性紫癜的MSCT表现及诊断价值。方法:回顾性分析经临床确诊的16例儿童腹型过敏性紫癜的MSCT表现。根据患儿入院时有无皮疹分为皮疹组和无皮疹组,其中皮疹组7例,无皮疹组9例。观察指标包括:①肠壁增厚的特点及受累肠腔的改变,并分析两组间各征象的出现率有无统计学意义;②肠周改变及其它伴发征象;③有无并发急腹症。结果:所有患儿均出现单发或多发节段性肠壁增厚,两组间差异无统计学意义(P>0.05)。13例受累肠管周围系膜脂肪密度增高,12例出现腹腔积液,3例伴有肾脏形态和/或密度异常,4例并发急腹症。结论:对于可疑腹型过敏性紫癜的患儿,特别是在未出现皮疹前行CT检查不仅可排除外科急腹症,且典型的CT表现可早期提供诊断依据,指导临床进一步治疗。

Objective：To analyze the value and the manifestations of multi-slice CT （MSCT） in the diagnosis of ab-dominaI type anaphylactoid purpura. Methods：The MSCT features of 16 pediatric patients with clinically diagnosed abdomi nal type anaphyiactoid pnrpura were retrospectively analyzed. According to whether the patients .at admission had skin rash or not, they were divided into two groups （with skin rash group：7 cases;with no skin rash group：9 cases）. Three parame- ters were used for grading, including： ①characteristics of intestinal wall thickening and changes of corresponding involved intestine, statistic differences were compared between the incidence of above mentioned parameters in each group②peri-in-testinal changes and other associated signs③presence or absence of concurrent acute abdomen. Results：All patients had sin-gle or multiple segmental bowel wall thickening,no statistical significant difference was existed （P〉0.05） between the two groups. 13 patients had increased attenuation of mesenteric fat adjacent to the involved bowel, 12 patients had ascites,3 ca-ses had abnormalities of the shape and/or density of kidney, 4 cases had concurrent acute abdomen. Conclusion：For a pediat- ric patient who was suspicious of having abdominal type anaphylaetoid purpura, yet with no skin rash,CT examination can not only exclude surgical acute abdomen, but also the typical CT manifestations provide evidence for early diagnosis and treatment guidance.