儿童支原体肺炎低剂量CT影像分期特点回顾研究

Retrospective study on staging characteristics of low-dose CT images in pediatric Mycoplasma pneumonia

目的回顾性研究2023年集中发生的儿童支原体肺炎低剂量CT分期表现。方法收集2023年8月—2023年11月间小儿支原体肺炎集中发生时在联勤保障部队第九八八医院住院治疗的90例经临床证实为儿童支原体肺炎的患儿胸部低剂量CT影像资料,对影像学特征进行回顾性研究。结果90例患儿中58例为轻症,其肺部CT仅为超早期、早期、吸收消散期改变,超早期:58例(100%),表现为右肺中叶、双肺下叶单发或多发局灶磨玻璃影等,病灶多位于外周带胸膜下。另25例(43.1%)双肺上叶散在或单发局灶磨玻璃影等。早期:58例(100%),表现为双肺下叶、右肺中叶病灶所在肺组织小叶间隔增厚,其间多发或散在磨玻璃密度影和小实变影。20例(34.4%)右肺上叶散在磨玻璃影。21例(36.2%)左肺上叶散在磨玻璃影。吸收消散期:58例轻症患者中35例(60.3%)病灶完全吸收,23例(39.6%)肺内残留条索、小结节影、网格影等。32例重症肺部CT表现:超早期、早期表现同轻症,但32例(100%)均为多发病灶,并向双肺中内带蔓延。快速进展期:双肺多发病灶快速融合为大片状高密度影,32例(100%)患者双肺下叶外周带及中间带高密度影均为实变病灶,其中17例(53.1%)可见空气支气管征。32例中19例(59.3%)双肺内带高密度影,密度较为淡薄,实变较轻。实变期:32例中20例(62.5%)病灶范围出现缩小趋势,少量磨玻璃病灶吸收。吸收消散期:32例(100%)双肺均有病灶残留,主要表现为片状、不规则型实变病灶,多发条索影,粗网格影、支气管牵拉性扩张、扭曲、管壁增厚,形成“袖口征”改变,胸膜增厚、粘连。结论2023年集中发生的儿童支原体肺炎低剂量CT分期表现具有一定特征性,对于指导临床诊治有所帮助。

Objective To retrospectively explore the low-dose CT staging manifestations of 90 cases of pediatric Mycoplasma pneumonia that occurred in 2023.Methods Low dose CT imaging data of 90 cases of pediatric Mycoplasma pneumonia admitted to No.988 Hospital of the Joint Service logistic Support Force of the People's Liberation Army from August 2023 to November 2023 were collected,and the imaging features were retrospectively analyzed.Results Among the 90 pediatric patients,58 cases were mild,and their lung CT only showed changes in the ultra early,early,and absorption and dissipation stages.Ultra early stage:58 cases(100%)showed single or multiple focal ground glass shadows in the middle lobe of the right lung and lower lobes of both lungs,with lesions mostly located in the peripheral subpleural zone.Another 25 cases(43.1%)had scattered or single focal ground glass opacities in both upper lobes of the lungs.Early stage:58 cases(100%)showed thickening of the interlobular septa in the lung tissue where the lesions were located in the lower lobe of both lungs and the middle lobe of the right lung,with multiple or scattered ground glass density shadows and small consolidation shadows.20 cases(34.4%)had scattered ground glass shadows in the upper lobe of the right lung.21 cases(36.2%)had scattered ground glass shadows in the upper lobe of the left lung.Absorption and dissipation period:Among 58 mild patients,35 cases(60.3%)had complete absorption of lesions,and 23 cases(39.6%)had residual bands,small nodular shadows,and grid shadows in the lungs.32 cases of severe lung CT manifestations:ultra early and early manifestations were the same as mild symptoms,but all 32 cases(100%)had multiple lesions and spread to the medial zone of both lungs.Rapid progression period:Multiple lesions in both lungs quickly fused into large high-density shadows.In 32 cases(100%),high-density shadows in the peripheral and intermediate bands of the lower lobes of both lungs were all solid lesions,with 17 cases(53.1%)showing air bronchogram signs.Among the 32 cases,19 cases(59.3%)had high-density shadows in both lungs,with relatively thin density and mild consolidation.Solidification period:Among 32 cases,20 cases(62.5%)showed a trend of narrowing of the lesion area,with a small amount of ground glass lesion absorption.Absorption and dissipation period:32 cases(100%)had residual lesions in both lungs,mainly manifested as patchy and irregular consolidation lesions,multiple cord shadows,coarse grid shadows,bronchial traction dilation,distortion,and thickening of the tube wall,forming"cuff sign"changes,pleural thickening,and adhesions.Conclusion The low-dose CT staging of pediatric Mycoplasma pneumonia,which occurred in 2023,has certain characteristics and is helpful for guiding clinical diagnosis and treatment.