以胸部侵犯为首发的儿童淋巴瘤的临床病理及MSCT分析

Clinical pathology and MSCT features in pediatric lymphoma with thoracopathy as the initial presentation

目的:探讨以胸部侵犯为首发的儿童淋巴瘤的临床病理及MSCT表现,以提高该病的诊断正确率。方法:回顾性分析我院27例以胸部侵犯为首发的儿童淋巴瘤MSCT影像学表现,包括肿瘤的位置、形态、大小、密度、强化特点、与邻近心脏大血管的关系、是否伴有胸腔积液及心包积液等,并分析其与临床病理的关系。结果:以胸部侵犯为首发的儿童淋巴瘤多表现为纵隔及肺门的巨大软组织肿块(21/27),呈分叶状或形态不规则,大多密度均匀(17/21),呈轻中度强化,多数血管被包埋(18/21),少数上腔静脉受压可引起颜面部水肿(2/21),常伴胸膜不规则增厚(11/21)和胸腔积液(16/21)、心包增厚及心包积液(9/21);20例因肿块累及肺门致支气管变窄,导致阻塞性肺炎或肺不张,引起咳嗽、气促等临床症状。胸壁可出现软组织肿块(9/27)或一侧水肿增厚(7/27)。结论:MSCT检查对以胸部侵犯为首发的儿童淋巴瘤的诊断有重要价值,纵隔及肺门的巨大软组织肿块、伴胸膜、心包膜不规则增厚,胸壁肿块等有利于淋巴瘤的诊断。

Objective:To discuss the clinical and MSCT features in pediatric lymphoma with chest invasion as the initial presentation,in order to improve its diagnostic accuracy.Methods:CT imaging data of 27 patients of lymphoma with chest invasion lesions as initial presentation were retrospectively analyzed.The CT findings such as the location,shape,size,density,enhancement mode of the lymphoma,relationship with adjacent heart and large vessels,with or without pleural and pericardial effusion were observed.Results:MSCT showed large soft tissue mass of the mediastinum and hilum in 21 cases.All cases were lobulated or irregular-shaped.The density of most tumors was homogeneous,which presented as mild-to-moderate enhancement.Eighteen cases embeded the neighborhood blood vessels.Superior vena cava was oppressed in two cases with facial edema.There were pleural thickening,pleural effusions,pericardial thickening and effusion in 11,16,and 9 cases respectively.Bronchus was oppressed by pulmonary hilar mass accompanying obstructive pneumonia and atelectasis in 20 patients with clinical symptoms such as cough and asthma.There were soft tissue masses of chest wall in 9 cases and edema of chest wall in 7 cases.Conclusion:MSCT examination is valuable in the diagnosis of pediatric lymphoma with chest invasion as the initial presentation.Suggestive diagnosis can be made in some patients when mediastinal and hilar bulky masses,pleural and pericardial irregular thickening,soft tissue masses of chest wall were recognized in CT.