儿童先天性肺气道畸形的CT误诊分析

Analysis of CT Misdiagnosis of Congenital Pulmonary Airway Malformations in Children

目的:探讨CT在儿童先天性肺气道畸形(CPAM)中的诊断价值并对其误诊原因进行分析。方法:2017年5月至2019年8月经病理证实的42例CPAM纳入研究,回顾其CT图像表现特征,分析误诊的病例及进行鉴别诊断。结果:42例均为单侧发病,位于右肺26例,左肺16例,以右肺下叶最多见(18/42,42.86%),病变以单个肺段受累为主(33/42,78.57%)。CPAM的CT表现根据囊肿形态及大小可分为单发大囊型(5/42,11.90%)、多发大囊型(21/42,50.00%)及多发小囊型(16/42,38.10%),单发大囊型CPAM的CT误诊率最高,多发大囊型次之,多发小囊型最低,且差异有统计学意义(P=0.033)。多发大囊型与多发小囊型CPAM伴感染(12/37,32.43%)较不伴感染(25/37,67.57%)的CT误诊率高,且差异有统计学意义(P=0.040)。结论:单发大囊型CPAM、多发大囊型与多发小囊型伴感染的CPAM的CT误诊率较高,诊断时应注意鉴别。

Purpose:To investigate the value of CT in the diagnosis of congenital pulmonary airway malformations(CPAM)in children and analyze the causes of misdiagnosis.Methods:Forty-two CPAM confirmed by pathologic results from May 2017 to August 2019 were included in this study.The CT image features were reviewed,and the causes of misdiagnosis and differential diagnosis were analyzed.Results:All the 42 cases were unilateral,26 cases were located in the right lung,16 cases in the left lung,and most of the lesions were found in the lower lobe of the right lung(18/42,42.86%),and most of them involved single lung segment(33/42,78.57%).The manifestations of CPAM on CT were divided into single large cyst(5/42,11.90%),multiple large cysts(21/42,50.00%),and multiple small cysts(16/42,38.10%)according to the cyst shape and size.The rate of misdiagnosis of single large cystic CPAM on CT was the highest,followed by multiple large cystic CPAM and the lowest was multiple small cystic CPAM,and the difference was with statistical significance(P=0.033).The misdiagnosis rate of multiple large cystic and multiple small cystic CPAM with infection(12/37,32.43%)was higher than that without infection(25/37,67.57%),and the difference was with statistical significance(P=0.040).Conclusions:The misdiagnosis rate of single large cystic CPAM,CPAM with multiple large cysts and multiple small cysts with infection is relatively high,so attention should be paid to differentiation during diagnosis.