Chest radiographic and computed tomographic manifestations in allergic bronchopulmonary aspergillosis

AIM: To investigate the chest radiographic and high resolution computed tomography (HRCT) chest manifestations in glucocorticoid-na?ve allergic bronchopulmonary aspergillosis (ABPA) patients. METHODS: This is a prospective observational study and includes 60 consecutive glucocorticoid-na?ve patients with ABPA who underwent chest radiography and HRCT of the chest (1.25 mm every 10 mm) in the routine diagnostic workup for ABPA. RESULTS: Chest radiographs were normal in 50% of cases. Of the remainder, most patients demonstrated permanent findings in the form of parallel line and ring shadows suggesting bronchiectasis. Consolidation was detected in 17 cases but in the majority, the corresponding HRCT chest scan showed mucus-filled bronchiectatic cavities. Chest HRCT was normal in 22 patients, while central bronchiectasis (CB) was demonstrated in the remaining 38 patients. Bronchiectasis extended to the periphery in 33%-43% depending on the criteria used for defining CB. The other findings observed on HRCT were mucoid impaction, centrilobular nodules and high-attenuation mucus in decreasing order of frequency. CONCLUSION: Patients with ABPA can present with normal HRCT chest scans. Central bronchiectasis cannot be considered a characteristic feature of ABPA as peripheral bronchiectasis is commonly observed. Consolidation is an uncommon finding in ABPA.

Lung cancer screening-don't forget the chest radiograph

Lung cancer is a major health burden and early detection only bears the possibility of curative treatment. Screening with computed tomography(CT) recently demonstrated a mortality reduction in selected patients and has been incorporated in clinical guidelines. Problems of screening with CT are the excessive number of false positive findings, costs, radiation burden and from a global point of view shortage of CT capacity. In contrast, chest radiography could be an ideal screening tool in the early detection of lung cancer. It is widely available, easy to perform, cheap, the radiation burden is negligible and there is only a low rate of false positive findings. Large randomized controlled trials could not show a mortality reduction, but different large population-based cohort studies have shown a lung cancer mortality reduction. It has been argued that community-based cohort studies are more closely reflecting the "real world" of everyday medicine. Radiologists should be aware of the found mortality reduction and realize that early detection of lung cancer is possible when reading their daily chest radiographs. Offering a chest radiograph in selected scenarios for the early detection of lung cancer is therefore still justified.

Lung cancer screening: Computed tomography or chest radiographs?

Worldwide, lung cancer is the leading cause of mortalitydue to malignancy. The vast majority of cases of lung cancer are smoking related and the most effective way of reducing lung cancer incidence and mortality is by smoking cessation. In the Western world, smoking cessation policies have met with limited success. The other major means of reducing lung cancer deaths is to diagnose cases at an earlier more treatable stage employing screening programmes using chest radiographs or low dose computed tomography. In many countries smoking is still on the increase, and the sheer scale of the problem limits the affordability of such screening programmes. This short review article will evaluate the current evidence and potential areas of research which may benefit policy making across the world.

Chest radiograph usefulness in the diagnosis of acute aortic dissection

Objective To assess the diagnostic value of chest radiographs in patients presenting to a busy inner-city Emergency Department with subsequently proven acute aortic dissection. Methods A retrospective review of initial chest radiographs and charts of patients with the confirmed diagnosis of acute aortic dissection was done for a period of 5 years from 1998 to 2003. A comparison was made between the initial readings of chest radiographs prior to confirmation of the aortic dissection, and a retrospective review of the same radiographs by two board-certified radiologists with special attention to the classic findings of acute aortic dissection identifiable on plain films. Results The charts of nine patients (four men, five women) with proven acute aortic dissection were reviewed. All nine patients were suspected of having acute aortic dissection based on presenting history and symptoms of chest pain (66% ), migratory pain (89% ), back pain (89% ), and the abruptness of onset of pain (89% ). Initial plain portable chest X-rays were obtained in the Emergency Department in all nine patients. Six of nine (67%) radiographs were read as normal, while three (33%) demonstrated a widened mediastinum (＞ 8.0cm), two (22%) showed an abnormal aortic contour, with one ( 11% ) displaying an apical cap. Confirmation of the diagnosis was obtained with either a spiral CT angiogram or transesophageal echocardiography (TEE). All nine plain radiographs were retrospectively reviewed by two board-certified radiologists aware of the diagnosis of acute dissection without a change in the readings. Conclusions Plain portable chest radiographs are of limited usefulness for the screening of acute aortic dissection. Further radiologic evaluation should be dictated by the clinical presentation and an awareness of the low sensitivity of portable chest X- rays.

Deformable Registration of Chest Radiographs Using B-spline Based Method with Modified Residual Complexity

Accurate registration of chest radiographs plays an increasingly important role in medical applications.However, most current intensity-based registration methods rely on the assumption of intensity conservation that is not suitable for alignment of chest radiographs. In this study, we propose a novel algorithm to match chest radiographs, for which the conventional residual complexity(RC) is modified as the similarity measure and the cubic B-spline transformation is adopted for displacement estimation. The modified similarity measure is allowed to incorporate the neighborhood influence into variation of intensity in a justified manner of the weight, while the transformation is implemented with a registration framework of pyramid structure. The results show that the proposed algorithm is more accurate in registration of chest radiographs, compared with some widely used methods such as the sum-of-squared-differences(SSD), correlation coefficient(CC) and mutual information(MI)algorithms, as well as the conventional RC approaches.

Algorithm fusion to improve detection of lung cancer on chest radiographs

Purpose-The purpose of this paper is to show an efficient method for the detection of signs of early lung cancer.Various image processing algorithms are presented for different types of lesions,and a scheme is proposed for the combination of results.Design/methodology/approach-A computer aided detection(CAD)scheme was developed for detection of lung cancer.It enables different lesion enhancer algorithms,sensitive to specific lesion subtypes,to be used simultaneously.Three image processing algorithms are presented for the detection of small nodules,large ones,and infiltrated areas.The outputs are merged,the false detection rate is reduced with four separated support vector machine(SVM)classifiers.The classifier input comes from a feature selection algorithm selecting from various textural and geometric features.A total of 761 images were used for testing,including the database of the Japanese Society of Radiological Technology(JSRT).Findings-The fusion of algorithms reduced false positives on average by 0.6 per image,while the sensitivity remained 80 per cent.On the JSRT database the system managed to find 60.2 per cent of lesions at an average of 2.0 false positives per image.The effect of using different result evaluation criteria was tested and a difference as high as 4 percentage points in sensitivity was measured.The system was compared to other published methods.Originality/value-The study described in the paper proves the usefulness of lesion enhancement decomposition,while proposing a scheme for the fusion of algorithms.Furthermore,a new algorithm is introduced for the detection of infiltrated areas,possible signs of lung cancer,neglected by previous solutions.

医学影像与自然语言处理多模态探索研究

目的/意义实现医学影像报告的自动生成对减轻放射科医生工作负担、促进临床工作流程标准化具有重要意义。方法/过程重点查找近几年公开源代码的胸部报告生成模型,开发一种基于CDGPT 2模型的医学影像报告自动生成方法。结果/结论大参数量的语言模型在报告生成方面的优势仍有待挖掘,对模型的解码器输入进行修改后生成报告的质量不高。未来研究可采用大型数据集并结合更多临床信息来提高模型性能。

C-reactive protein and radiographic findings of lower respiratory tract infection in infants

AIM To evaluate the association between C-reactive protein(CRP) and radiological evidence of lower respiratory tract infection(LRTI) in infants.METHODS All patients aged less than 4 years who presented with suspected lower respiratory tract infection,who received a peri-presentation chest radiograph and CRP blood measurement over an 18-mo period were included in the study.Age,gender,source of referral,CRP,white cell count,neutrophil count along with the patients' symptoms and radiologist's report were recorded.RESULTS Three hundred and eleven patients met the inclusioncriteria.Abnormal chest radiographs were more common in patients with elevated CRP levels(P < 0.01).Radiologic signs of LRTI were identified in 73.7% of chest radiographs when a patient had a CRP level between 50-99 mg/L.CRP levels were a better predictor of positive chest radiograph findings for those aged greater than I year compared to those 1 year or less.CONCLUSION CRP may be used in patients with suspected LRTI diagnosis to select those who are likely to have positive findings on chest radiograph,thus reducing unnecessary chest radiographs.

社区人群新型冠状病毒性肺炎辅助诊断技术应用价值分析

目的:探讨新型冠状病毒疫情管控开放后,社区新型冠状病毒性肺炎人群常规辅助检查诊断技术应用价值。方法:分析2022年12月12日至2023年1月20日在发热哨点就诊的330例新型冠状病毒核酸阳性及(或)抗原阳性者检查资料,其中男性123人､女性207人,年龄14~95岁。分析胸片和血常规指标特征。结果:胸片检查发现146人符合病毒性肺炎征象,阳性率44.2%。其中轻度肺炎69.17%,中度肺炎30.82%。各年龄段新型冠状病毒性肺炎发生率差异无统计学意义(P>0.05)。外周血淋巴细胞减少、正常、升高三组间的新型冠状病毒感染者发生肺炎风险的差异具有统计学意义(P<0.05);肺炎组C反应蛋白升高比例高于无肺炎组,差异具有统计学意义(P<0.05)。结论:外周血的淋巴细胞计数可作为早期预测、分型及评估病情转归的生物学指标;C-反应蛋白升高对反应性病理改变为判断病程及病情严重程度的重要指标;外周血的白细胞指数改变能有效地提高对混合性感染类型诊断的灵敏度。胸部数字放射影像技术能满足基层医疗临床需要。常规辅助诊断技术对新型冠状病毒性肺炎患者筛查和诊治有一定临床应用价值。

数字化DR胸部正斜位摄片在急诊肋骨骨折患者中的诊断价值

目的:探讨与分析数字化DR胸部正斜位摄片在急诊肋骨骨折患者中的诊断价值.方法:选择2021年8月—2023年5月我院收治的192例急诊肋骨骨折患者为研究对象,所有患者都给予传统X线与数字化DR胸部正斜位摄片检查,同时所有患者都给予手术检查,判断诊断价值.结果:在192例患者中,数字化DR胸部正斜位摄片检查的图像优良率为97.40%,高于传统X线的84.90%,差异有统计学意义(P<0.05).手术确诊为肋骨骨折142例(骨折组),其中隐匿性骨折32例、多发性骨折68例、单发性骨折42例.传统X线判断为肋骨骨折126例,其中隐匿性骨折26例、多发性骨折64例、单发性骨折36例.数字化DR胸部正斜位摄片判断为肋骨骨折141例,其中隐匿性骨折31例、多发性骨折68例、单发性骨折42例.数字化DR胸部正斜位摄片对隐匿性骨折、多发性骨折、单发性骨折的检出率为96.88%、100.00%、100.00%,传统X线为81.25%、94.12%、85.71%,组间比较差异有统计学意义(P<0.05).传统X线与数字化DR胸部正斜位摄片诊断肋骨骨折的灵敏度为87.32%、99.30%,特异性为96.00%、100.00%,数字化DR胸部正斜位摄片诊断肋骨骨折的灵敏度高于传统X线,组间差异有统计学意义(P<0.05).结论:数字化DR胸部正斜位摄片在急诊肋骨骨折患者中的应用具有很高的图像优良率,对不同类型的骨折都有很高的检出率,还可提高诊断的总体灵敏度.

慢性阻塞性肺疾病动态胸X线片膈肌运动与呼吸功能评估的意义

目的:评价动态胸X线片膈肌运动在慢性阻塞性肺疾病(COPD)呼吸功能评估中的意义。方法:选取我院就诊的96例稳定期COPD患者和50例健康受试者,完成肺功能检查及动态胸片检查。获得肺通气功能及动态胸X线片横膈移动幅度、速度及时间等参数。分析并对比两组间肺功能和动态胸片各参数的差异,评估动态胸片各参数在COPD呼吸功能评估中的价值。结果:COPD组FEV1、FEV1%pre以及FEV1/FVC均低于健康受试组,且差异均有统计学意义(P<0.01)。平静呼吸时,COPD组双侧膈肌运动幅度、双侧膈肌上升速度和双侧膈肌下降速度均高于健康受试组,且均差异有统计学意义(P<0.05)。用力呼吸时,COPD患者吸气时间和呼气时间以及双侧膈肌运动幅度均小于健康受试者,且均差异有统计学意义(P<0.05)。用力呼吸时,双侧膈肌运动幅度与肺功能各项指标均成正相关。对动态胸X线片参数做K-均值聚类分析,各变量对聚类结果的重要程度前五位分别为:用力呼吸左侧膈肌运动幅度(F=86.88),用力呼气左侧膈肌运动速度(F=79.37),用力吸气左侧膈肌运动速度(F=77.41),用力吸气右侧膈肌运动速度(F=72.28),用力呼吸右侧膈肌运动幅度(F=54.46)。结论:动态胸X线片可以精准评估双侧横膈的运动状态,与肺功能参数一致性好,可以作为COPD的肺功能评估的补充工具。

INTER-OBSERVER VARIATIONS OF DIGITAL RADIOGRAPH PULMONARY NODULE MARKING BY USING COMPUTER TOOLKIT

Objective To assess inter-observer variations of pulmonary nodule marking in routine clinical chest digital radiograph (DR) softcopy reading by using a lung nodule computer toolkit.Methods A total of 601 chest posterior-anterior DR images were randomly selected from routine outpatient screening in Peking Union Medical College Hospital. Two chest radiologists with experience more than ten years were first asked to read the images and mark all suspicious nodules independently by using computer toolkit IQQA-Chest, and to indicate the likelihood for each nodule detected. They were also asked to draw the boundary of the identified nodule manually on an enlarged region of interest, which was instantly analyzed by IQQA-Chest. Two sets of diagnostic reports, including the marked nodules, likelihood, manually drawn boundaries, quantitative measurements, and radiologists’ names, were automatically generated and stored by the computer system. One week later, the two radiologists read the same images together by using the same computer toolkit without referring to their previous reading results. Marking procedure was the same except that consensus was reached for each suspicious region. Statistical analysis tools provided in the IQQA-Chest were used to compare all the three sets of reading results.Results In the independent readings, Reader 1 detected 409 nodules with a mean diameter of 12.4 mm in 241 patients, and Reader 2 detected 401 nodules with a mean diameter of 12.6 mm in 253 patients. In the consensus reading, a total of 352 nodules with a mean diameter of 12.4 mm were detected in 220 patients. Totally, 42.3% of Reader 1’s and 45.1% of Reader 2’s marks were confirmed by the consensus reading. About 40% of each reader’s marks agreed with the other. There were only 130 (14.4%) out of the total 904 unique nodules were confirmed by both readers and the consensus reading. Moreover, 5.6% (51/904) of the marked regions were rated identical likelihood in all three readings. Statistical analysis showed significant differences between Readers 1 and 2, and between consensus and Reader 2 in determining the likelihood of the marks (P<0.01), but not between consensus and Reader 1. No significant difference in terms of size was observed in nodule segmentation between either two of the three readings. Conclusion Large variations in nodule marking and nodule-likelihood determination but not in nodule size were observed between experts as well as between single-person reading and consensus reading.

改良版肺超声评分法对比胸片定量评估新生儿呼吸窘迫综合征严重程度

目的:通过对比新生儿呼吸窘迫综合征(NRDS)患儿的胸片结果,探讨改良版肺超声评分法定量评估NRDS患儿病情严重程度的效能及价值。方法:选取临床诊断为NRDS的患儿23例(病例组)和临床诊断无肺部疾病的患儿30例(对照组)。病例组患儿均行胸片检查及改良版肺超声评分。病例组胸片检查及超声评分均为40次(包括复查病例),对照组行超声评分30次。比较病例组与对照组的超声评分。对病例组的超声评分与NRDS的严重程度进行相关性分析。病例组依据胸片分级分为4组,通过绘制受试者工作特征(ROC)曲线,分析超声评分的诊断效能并得出各组间截断值。结果:病例组和对照组的超声评分分别为(16.3±9.6)分、(0.5±0.8)分,病例组肺超声评分显著高于对照组,差异有统计学意义(P<0.05)。相关性分析结果显示,病例组肺超声评分与NRDS的严重程度存在正相关关系且相关性显著(r=0.635,P<0.01)。ROC曲线分析结果显示,病例组各组间超声评分截断值分别为10.5、18.5、25.5,曲线下面积分别为0.877、0.891、0.920,对应约登指数为0.688、0.680、0.796,敏感度为0.813、0.800、0.857,特异度为0.875、0.880、0.939。结论:改良版肺超声评分法可定量评估新生儿呼吸窘迫综合征的严重程度,并且分数越高病情越严重。

在普通DR胸片架摄影系统中实现长骨拼接技术

目的 利用普通DR胸片摄影系统实现长骨拼接技术。方法 简述了长骨拼接技术在医学诊疗中的作用,以及长骨拼接技术实现的原理,制作了长骨拼接摄影装置,结合胸片摄影装置进行了长骨拼接摄影实验。结果 应用此装置,使得二级以下医院能在普通DR设备上实现长骨拼接摄影。结论 可节约医院成本,减轻患者负担,能取得良好的经济效益和社会效益。

MP P患儿血浆sB7-H3水平与疾病严重程度及临床和影像学特征的关系

目的:分析肺炎支原体肺炎(MP P)患儿血浆可溶性B7-H3(sB7-H3)水平与疾病严重程度及临床和影像学特征的关系。方法:收集2018年1月至2022年6月在我院诊断为MP P的14岁以下住院儿童共382例,采集入院后24 h内的外周血样本。同时选择200例在我院接受择期手术的无任何感染证据的儿童作为对照组。采用酶联免疫吸附试验法检测血浆sB7-H3和细胞炎症因子水平。分析MP P患儿的临床特征和胸片影像学表现。结果:与对照组相比,MP P患儿基线血浆sB7-H3水平显著升高(P<0.001),且重度MP P患儿基线血浆sB7-H3水平显著高于轻度MP P患儿(P<0.001)。血浆sB7-H3高水平亚组患儿咳痰、低氧血症、心动过速、肺部湿啰音、肺外表现、胸腔积液等临床症状和体征更常见,且白细胞计数、血小板计数、C反应蛋白水平更高(P<0.05)。经多因素Logistic回归分析,基线血浆sB7-H3水平升高是重度MP P的独立危险因素(P<0.05)。经受试者工作特征曲线分析,基线血浆sB7-H3(AUC:0.855)水平对于区分轻度MP P和重度MP P患儿有良好的价值。此外,经Spearman相关性分析,MP P患儿基线血浆sB7-H3水平与发热持续时长,抗生素使用时长,住院时长,炎症细胞因子γ-干扰素、白细胞介素-17、粒细胞-巨噬细胞集落刺激因子均呈正相关(P<0.001)。实变亚组患儿基线血浆sB7-H3水平显著高于非实变亚组(P<0.001)。结论:MP P患儿基线血浆sB7-H3水平普遍升高,高sB7-H3水平预示着机体炎症反应更严重,肺叶或节段性实变可能性更高,sB7-H3可作为区分重度MP P和轻度MP P的有价值的生物标志物。

支气管肺泡灌洗术治疗时机对重症支原体肺炎伴肺不张患儿影像学恢复的影响

目的:探索儿童重症肺炎支原体肺炎伴肺不张治疗中支气管肺泡灌洗术(bronchoalveolar lavage,BAL)的不同治疗时机与胸片恢复的关系。方法:选取 2017 年 1 月至 2018 年 2 月期间于重庆医科大学附属儿童医院确诊的重症肺炎支原体肺炎伴肺不张的患儿作为研究对象,根据行支气管肺泡灌洗术时病程分为 A 组(≤10 d,55 例)、B 组(10~20 d,94 例)、C 组(≥21 d,66例)。分别于术后 1 周及术后 1 个月左右复查胸片,比较 3 组患儿肺不张吸收情况。结果:3 组患儿术后 1 周随访胸片恢复情况比较:Kruskal-Wallis H 检验:χ^2=39.542,P=0.000。说明 3 组患儿术后 1 周随访胸片恢复情况存在统计学意义。进一步进行组间两两比较,A 组与 B 组比较(PAB=0.026);A 组与 C 组比较(PAC=0.000);B 组与 C 组比较(PBC=0.000);说明 3 组患儿术后 1 周随访胸片吸收情况,A 组优于 C 组,B 组优于 C 组,A 组及 B 组无明显差别。 3 组患儿术后 1 月随访胸片恢复情况比较:Kruskal-Wallis H 检验:χ^2=58.717,P=0.000。说明 3 组患儿术后 1 月胸片恢复情况存在统计学意义。进一步进行组间两两比较显示:A 组与 B 组比较(PAB=0.01);A 组与 C 组比较(PAC=0.000);B 组与 C 组比较(PBC=0.000);组间两两比较均具有统计学意义,说明 3 组患儿术后 1 月随访胸片恢复情况均存在差异,吸收情况 A 组优于 B、C 组,B 组优于 C 组。结论:对于重症肺炎支原体肺炎伴肺不张的患儿,BAL 早期介入(10 d 以内)有助于减轻病情、促进影像学恢复,从而改善预后。

严重急性呼吸综合征(非典型肺炎)的胸片研究

目的 分析严重急性呼吸综合征 (severeacuterespiratorysyndrome ,SARS)患者治疗前后的X线表现 ,探讨胸片在SARS诊断与治疗中的临床价值。方法 61例SARS患者在治疗前与治疗后的不同时间作了胸部X线平片检查。男 2 3例 ,女 3 8例 ,年龄 17～ 63岁 ,平均 3 3岁。观察一系列X线平片表现。结果 61例均见肺纹理增粗 ,2 3例并网格状改变 ,肺内见薄雾状 ( 10例 )、云絮状 ( 3 3例 )、浓烟状 ( 11例 )或磨玻璃样 ( 2 3例 )阴影。首诊时肺内阴影在单侧单叶 2 9例 ,单侧多叶 9例 ,双侧 2 3例。 3 8例阴影出现在单侧者 ,2 8例在右侧 ( 74% )。肺内阴影共累及 12 9个肺叶 ,下肺叶 71个 ( 5 5 % )。患者还合并膈胸膜增厚 ( 6例 )、纵隔气肿 ( 3例 )、心影增大 ( 1例 )。 18例胸片随访见肺部阴影增多 ,其中 13例阴影由单侧向双侧发展。激素治疗可使肺部阴影在 4～ 3 7天后吸收。结论 SARS的胸片表现多种多样 ,无特异性。但胸片检查是SARS诊断、疗效观察及指导治疗的必需手段。

儿童肺结核420例临床分析

目的提高对儿童肺结核的认识和诊断水平,以减少误诊。方法回顾性分析2002年1月-2007年12月收治的420例肺结核患儿的临床和影像资料。结果420例中男260例(61.9%),女160例(38.1%);3岁以下210例(50.0%),10岁以上114例(27.1%)。85%患儿PPD在++以上,6.2%为阴性。46.4%患儿未接种卡介苗,32.4%患儿有活动性肺结核病人接触史。82.4%患儿以发热为主要表现,48.8%伴咳嗽,11.4%伴喘息。54.5%病程中曾误诊为其他病原引起的肺炎和胸膜炎、支气管异物、发热待查和纵隔占位等,误诊时间2周～4个月。胸片中83.3%患儿存在肺内实质浸润,75.2%肺门增大和上纵隔增宽,合并两肺粟粒影占20.2%,肺CT在各方面检出的阳性率均优于胸片。33.1%患儿合并结核性脑膜炎、腹腔结核病或骨关节结核等肺外结核病。结论小儿肺结核发病以婴幼儿多见,其次为青春期儿童,不同年龄患儿表现为不同的临床类型。卡介苗接种史、结核接触史以及PPD试验是诊断的重要线索。各型肺结核具有相对特异的影像学特征,肺内实质浸润伴肺门或纵隔淋巴结肿大是小儿原发肺结核基本的影像特征,肺CT较胸片有更大诊断价值。相当比例的肺结核患儿合并肺外结核病,对诊断可以起到互为提示作用。

先天性支气管闭锁的影像学表现

目的分析先天性支气管闭锁(CBA)的影像学表现。资料与方法回顾性分析5例CBA的临床和影像学表现,并结合文献复习。5例均行X线及CT检查,1例行普通X线断层摄影,2例行MRI检查。结果X线胸片示3例肺门区肿块样阴影,1例局部肺野多发结节阴影,1例囊肿周围肺野过度透亮。胸部CT示5例黏液囊肿显示为多发分支状和棍棒状肿块或结节样阴影及周围肺野的过度充气改变。2例显示周围肺野支气管扩张改变。2例胸部MRI示囊肿T1、T2均为高信号。结论黏液囊肿和周围肺野的过度充气是CBA典型表现,CT对CBA的诊断优于其他影像学检查方法。

特发性肺含铁血黄素沉着症误诊21例

目的探讨儿童特发性肺含铁血黄素沉着症（IPH）的误诊情况及其临床特点。方法回顾性分析本院1993年6月-2007年5月收治的曾误诊的21例IPH的临床资料。男9例，女12例；发病年龄1～14岁；病程1～6个月。所有患儿均通过胸部X线片、胸部cT、骨髓穿刺检查、痰、胃液或支气管肺泡灌洗液检查发现含铁血黄素巨噬细胞而确诊，分析IPH患儿的治疗情况及预后。结果21例患儿有程度不同的贫血，咳嗽11例（52．38％），发热9例（42．86％），纳差、乏力6例（28．50％），咯血4例（19．05％）。X线胸片及cT呈点网状、斑片状改变。行骨髓常规检查18例，均显示增生性骨髓像。其中4例（22．2％）伴缺铁性贫血改变；痰、胃液或支气管灌洗液检查找到含铁血黄素巨噬细胞19例（90．50％）。21例均被误诊，误诊为支气管肺炎并轻度贫血8例，肺结核并贫血5例，缺铁性贫血4例，溶血性贫血3例，骨髓增生异常综合征1例。确诊IPH后行肾上腺皮质激素治疗，均有效。其中4例联合使用大剂量人血丙种球蛋白治疗，3例联合使用长春新碱治疗。随访18例，其中3例痊愈并停止治疗2a以上，11例患儿临床持续缓解，4例病情反复有恶化趋势。结论儿童IPH易误诊，早期诊断、长期正规治疗对尽早控制急性发作、减少复发次数、改善预后有重要的作用。