摘要
结核病是全球十大死亡原因之一。结核杆菌易通过血行播散累及全身各脏器。儿童是结核菌易感人群,急性血行播散性肺结核在儿童最多见,其中包括部分先天性肺结核。急性血行播散性肺结核的影像学可表现为双肺弥散均匀分布的粟粒影/结节影,病灶大小一致,密度相等,随机分布,伴肺门、纵隔淋巴结大及钙化。小年龄患儿血行播散型肺结核结节较大,易融合。亚急性/慢性血行播散性肺结核结节大小不一,密度不等,随机分布,渗出与增殖性改变相互混杂。先天性肺结核常于出生1个月内发病,表现为弥散粟粒影或广泛分布的结节及斑片影,病灶可发生融合,可伴纵隔及肺门淋巴结增大。幼儿血行播散性肺结核的鉴别诊断主要考虑慢性肉芽肿病、衣原体肺炎,儿童血行播散性肺结核的鉴别诊断需要考虑隐球菌肺炎、血源性金黄色葡萄球菌肺炎、血行播散型肺曲霉菌病、气管支气管结核、过敏性肺炎、巨细胞病毒肺炎、肺朗格罕组织细胞增生症、肺淋巴管瘤病、肿瘤肺转移、肺霍奇金/非霍奇金淋巴瘤、特发性肺含铁血黄素沉着症、尼曼-匹克病等。现对儿童血行播散型结核的分类及影像学特征进行总结,并结合临床经验,对儿童血行播散型结核的诊断及鉴别诊断进行阐述,旨在提高对该病的影像学认识和影像学诊断水平。
Tuberculosis is in the top 10 fatal disease in the world.Mycobacterium tuberculosis can easily spread through blood and affect all organs of the body.Children are susceptible to tuberculosis,most of which is acute hematogenous disseminated tuberculosis,including some congenital tuberculosis.The imaging features of acute hema-togenous disseminated pulmonary tuberculosis are miliary nodules/nodules of the same size and evenly and randomly distributed and dispersed in both lungs,accompanied by hilar and mediastinal adenopathy and calcification.Young children with hematogenous disseminated tuberculosis have relatively large nodules which easy to fuse.The imaging features of subacute/chronic hematogenous disseminated pulmonary tuberculosis are randomly distributed nodules with different sizes and densities as well as mixed exudative and proliferative lesions.Congenital tuberculosis usually occurs in neonates within 1 month characterized by diffuse miliary nodules or consolidation lesions.The lesions can be fused,accompanied by mediastinum and hilar adenopathy.The differential diagnosis of pediatric hematogenous disseminated pulmonary tuberculosis in infants includes chronic granulomatosis and chlamydia pneumonia,and in old children includes cryptococcus pneumonia,staphylococcus aureus pneumonia,hematogenous pulmonary aspergillosis,tracheobronchial tuberculosis,allergic pneumonia,cytomegalovirus pneumonia,lung Langerhans histiocytosis,pulmonary metastasis,pulmonary lymphangiomatosis,pulmonary lymphoproliferative diseases,idiopathic pulmonary hemosiderosis,Niemann Pick′s disease,etc.The classification and imaging characteristics of children′s hematogenous disseminated tuberculosis were systematically studied and summarized in this review,and the diagnosis and differential diagnosis of hematogenous disseminated tuberculosis in children was reviewed based on the author′s clinical experience,in order to improve the imaging recognition and diagnosis of the disease.
作者
于彤
王蓓
段晓岷
彭芸
Yu Tong;Wang Bei;Duan Xiaomin;Peng Yun(Imaging Center,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2020年第10期733-737,共5页
Chinese Journal of Applied Clinical Pediatrics
关键词
儿童
血行播散型肺结核
影像诊断
鉴别诊断
体层摄影扫描仪
Child
Hematogenous disseminated pulmonary tuberculosis
Imaging diagnosis
Differential diagnosis
Tomography scanner
