儿童气道异物的临床和CT诊断

Foreign Body Aspiration in Children: Clinical and CT Diagnosis

目的：分析儿童气道异物临床及影像学特点，提高对儿童气道异物的认识，减少误诊、漏诊。方法：分析590例气道异物患儿的临床及影像学资料，对其发病规律、临床特点及影像学资料进行统计分析。结果：经CT检查并三维重建、纤维支气管镜及临床共确诊590名气道异物儿童，好发年龄为1～3岁，左侧及右侧气道发病率之比为1．05：1，常见并发症有肺气肿、肺炎及肺不张，少见合并症有椎管积气等。气道异物种类繁多，花生最多见。CT三维重建诊断的灵敏度为99．83％，特异度99．89％，后处理图像使异物显示更加清晰、直观。结论：儿童气道异物常见，CT三维重建有助于显示异物，典型临床表现和CT表现有助于诊断。

Purpose： The aim of this study was to improve the understanding of foreign body aspiration （FBA） in children and to lower the rate of misdiagnosis, missed diagnosis and morbidity. Methods： One thousand five hundred and one children, who underwent the three-dimensional reconstructed （3D） CT between January 2009 and July 2010 for the evaluation of children with suspected foreign body aspiration, were included in this study. Five hundred and eighty-four children were confirmed by bronchoscope, 6 children coughed foreign bodies out themselves. We analyzed the clinical features and the CT images of 590 children with FBA. Results： CT imaging revealed common complications of FBA including emphysema, pneumonia and atelectasis. Serious complications including pneumothorax, pneumomediastinum, subcutaneous emphysema, pneumatorrhachis could also be observed. The types of foreign bodies were diverse： the most common were peanuts. The diagnostic accuracy of the 3D CT imaging was high, with sensitivity and specificity of 99.83% and 99.89 %, respectively. Conclusion： FBA is common in children. CT scan with post-processing is helpful to reveal FBA. Typical clinical and CT findings can be helpful for the diagnosis.