儿童先天性肺气道畸形的影像诊断及误诊分析

Imaging Diagnosis and Misdiagnosis of Congenital Pulmonary Airway Malformation in Children

目的分析儿童先天性肺气道畸形(CPAM)的影像表现及误诊原因,减少误诊率。方法依据Stocker 5型分法回顾性分析经手术病理证实的152例CPAM的影像学资料。结果 152例CPAM患儿,男91例,女61例,年龄2天~13岁。142例行X线检查,142例行CT检查。X线检查阳性率为83.8%,准确率为61.3%,55例出现误诊(漏诊),其中23例X线呈阴性表现而漏诊;10例表现为肺野局限性透亮度增高,误诊为肺气肿、肺大泡;17例表现为肺炎和(或)软组织影,误诊为单纯肺炎、脓肿或肿瘤;5例X线表现为气胸样改变,误诊为气胸。CT检查阳性率及准确率为100%及95.1%,7例出现误诊,其中3例误诊为肺脓肿,4例误诊为单纯肺隔离症。结论 CPAM以肺内囊肿为主要影像表现,合并其他畸形或并发症容易导致误诊和(或)漏诊,紧密结合病史以及治疗后复查可以减少误诊率。CT检查的诊断阳性率及准确率明显高于X线检查。

Objective Analysis of the imaging features and causes of misdiagnosis of congenital pulmonary airway malformation in children,reducing the rate of the misdiagnosis.Methods Retrospective analysis of 152 cases of CPAM confirmed by surgical pathology based on type 5 classification of Stocker.Results There were 152 CPAM cases,91 males and 61 females,aged from 2 days to 13 years.142 cases of X-ray examination,and 142 cases of CT examination.The positive rate of X-ray examination was 83.8%,and the accuracy rate was 61.3%.55 cases of misdiagnosis(missed diagnosis):23 cases of X-ray were negative;10 cases showed increased luminance of lung field and were misdiagnosed as emphysema and pulmonary bullae;17 cases showed pneumonia and(or)soft tissue,misdiagnosed as pneumonia,abscess or tumor;5 cases of X-ray showed pneumothorax-like changes,misdiagnosed as pneumothorax.The positive rate and accuracy of CT examination were 100%and 95.1%.7 cases were misdiagnosed:3 cases were misdiagnosed as pulmonary abscess,and 4 cases were misdiagnosed as pulmonary sequestration.Conclusion The main imaging manifestations of CPAM were intrapulmonary cysts.When this appearance is combined with other malformations or complications it can lead to misdiagnosis(missed diagnosis).Close correlation of medical history and reexamination after treatment can reduce the rate of misdiagnosis.Secondly,the positive diagnostic rate and accuracy of CT examination was significantly higher than the X-ray.