儿童肺空洞性病变的鉴别诊断

Differential diagnosis of pulmonary cavitary lesions in children

儿童肺空洞性病变包括一组异质性疾病,主要由感染所致,其影像学特征可类似,实际临床工作中很难严格地将空洞与大疱、囊肿、气肿等病变区分开来。有学者将壁厚≤4 mm定义为薄壁,而>4 mm定义为厚壁,因而认为厚壁者为空洞,薄壁者为囊肿,但是两者在病因学和病理生理学方面存在重叠,影像学上二者有时难以区分鉴别,尚需结合病史特点寻找疾病病因。该文从感染性与非感染性病因方面着手,结合胸部影像学检查,对儿童肺空洞性病变性质进行分析总结,为临床上鉴别各种肺空洞提供诊断思路,从而指导临床治疗。

Pulmonary cavitary lesions in children consist of a group of heterogeneous diseases,mainly caused by infections,and their imaging manifestations can be similar.It is clinically difficult to distinguish them from other lesions such as bullae,cyst,and emphysema.Some scholars have advanced a concept about thin wall(4 mm or less)and thick wall(more than 4mm).People tried to make this distinction by defining cyst as a thin wall and cavity as a thick wall,but there are considerable overlaps between the two categories in etiology and pathophysiology.They are sometimes difficult to distinguish for imageology,and it is still necessary to find the cause of the disease based on the characteristics.This review divides etiology into two categories:infectious and non-infectious etiology.Combined with chest imaging examination,the purpose is to analyze and summarize the features of pulmonary cavitary lesions in children,and provide a diagnostic idea for differentiating various pulmonary cavities to guide clinical treatment.