儿童先天性梨状窝瘘的临床及超声影像特征

The clinical and ultrasonographic features of congenital pyriform sinus fistula in children

目的:探讨儿童先天性梨状窝瘘(Congenital pyriform sinus fistula,CPSF)的临床及超声影像特征。方法:回顾性分析2018年10月—2020年10月在西安市儿童医院经临床确诊的CPSF患儿32例。整理患儿的基本资料、病史、临床表现、超声影像及结果,总结其声像图特征及临床意义。结果:①32例CPSF患儿中,男女比例无明显差异,首次发病年龄2~17岁,病程1月~4年。所有病变均为单发,好发于左侧(96.9%)。临床表现以复发性颈部肿块、颈部脓肿及急性化脓性甲状腺炎为主。本病感染时易累及同侧甲状腺(84.4%),以上极受累为主。19例(59.4%)患儿初诊时有院外误诊史。②所有CPSF均位于同侧颈动脉鞘内侧,声像图表现为梨状窝至甲状腺侧叶的无回声区,伴有密集点状气体强回声。炎症静止期7例均可清晰显示瘘管。炎症感染期25例为颈深部脓肿,同侧甲状腺受到不同程度的炎症累及,表现为侧叶部分移位,回声不均匀减低,边界模糊,轻者仅局限于上极,重者可累及整个侧叶,但不影响峡部。超声可进一步评估疾病引起的气管受压移位、纵隔脓肿及肺叶受累等严重并发症。结论:高频超声在CPSF的诊断中有着特征性的声像图表现,可评估瘘管感染、甲状腺受累和严重并发症的情况,为早期诊断及治疗方式的选择提供可靠的影像学依据,提高疾病诊治率,在后续的随访复查中也起着重要作用。

Objective:To investigate the ultrasonographic features of congenital pyriform sinus fistula(CPSF)in children.Methods:From October 2018 to October 2020,32 children with CPSF who were clinically diagnosed in Xi’an children’s hospital were analyzed retrospectively.The basic data,medical history,clinical manifestations,ultrasound images and results of each case were collected,and the sonographic features and clinical significance were summarized.Results:①There was no significant difference in the ratio of male to female in 32 children with CPSF.The age of first onset ranged from 2 to 17 years old,and the course of disease ranged from 1 month to 4 years.All lesions were single,and most of them occurred on the left side(96.9%).The main clinical manifestations were recurrent neck mass,neck abscess and acute suppurative thyroiditis.The ipsilateral thyroid gland was easily involved when the disease was infected(84.4%).Ninteen cases(59.4%)had a history of misdiagnosis outside the hospital.②All CPSF were located on the inside of the ipsilateral carotid sheath,and the sonogram showed the anechoic area from pyriform sinus to the lateral lobe of thyroid,accompanied by dense dotted gas strong echo.The fistula could be clearly shown in 7 cases in the quiescent stage of inflammation.During the period of inflammation and infection,25 cases were deep cervical abscess,and the ipsilateral thyroid gland was invaded by inflammation,which was characterized by partial displacement of lateral lobe,uneven decrease of echo and blurred boundary,which was limited to the upper pole in mild cases,and the whole lateral lobe could be involved in severe cases,but did not affect the isthmus.Ultrasound can further evaluate the serious complications such as tracheal compression displacement,mediastinal abscess and pulmonary lobe involvement caused by the disease.Conclusion:High frequency ultrasound has characteristic sonographic findings in the diagnosis of CPSF,which can evaluate fistula infection,thyroid involvement and serious complications,provide reliable imaging basis for early diagnosis and treatment,improve the rate of diagnosis and treatment,and play an important role in the follow-up.