儿童胸壁病变的影像表现与临床分析  

The imaging diagnosis and clinical analysis of chest wall lesions in children

作　　者：吴朔春[1] 袁新宇[1] 孙雪峰[1] 孙海林[1] 王婷 许书聪 WU Shuochun;YUAN Xinyu;SUNXuefeng;SUN Hailin;WANG Ting;XU Shucong(Department of Radiology,Capital Pediatric Institute of Children,Beijing 100020,China;Department of Radiology,Inner Mongolia Autonomous Region People s Hospital)

机构地区：[1]首都儿科研究所附属儿童医院放射科,北京100020 [2]内蒙古自治区人民医院放射科

出　　处：《国际医学放射学杂志》2018年第5期525-528,557,共5页International Journal of Medical Radiology

摘　　要：目的探讨儿童胸壁病变的临床及影像表现特点,提高对胸壁病变的诊断水平。方法收集我院2009年10月—2018年6月经手术及病理证实的50例胸壁病变患儿,包括感染组(4例)和非感染组(46例),非感染组进一步分为良性肿瘤组(41例)和恶性肿瘤组(5例)。50例患儿均行超声、CT或MRI检查。对所有病例的临床及影像表现进行回顾性分析。结果 3组病例的临床及影像表现各有不同。①临床表现:感染组病人全部出现发热、胸痛、病灶局部红肿热的临床表现,且病变均质软;良性肿瘤组中质软出现率为90.2%(37/41);恶性肿瘤组全部病变均质韧。3组病变移动性均差。感染组及恶性肿瘤组全部病例均有局部压痛,而良性肿瘤组压痛的发生率仅为7.3%(3/41)。②影像表现:良性肿瘤组中,75.6%(31/41)病变显示内部均匀,65.9%(27/41)边缘清晰;而感染组及恶性肿瘤组病灶内部不均匀,边缘模糊。良性肿瘤组中仅9.8%(4/41)病灶可见钙化,2.4%(1/41)病灶有出血,19.5%(8/41)病灶内部出现囊腔影,14.6%(6/41)病例可见肋骨破坏;恶性肿瘤组全部侵犯入胸腔并破坏肋骨;感染组均无肋骨破坏。感染组与恶性肿瘤组病变均呈明显强化,而良性肿瘤组中80.5%(33/41)表现为无/轻度强化。结论不同性质胸壁病变临床特点各异,结合临床和影像特征可更好地诊断胸壁病变。Objective To explore the imaging and clinical features of chest wall lesions so as to improve diagnosis accuracies of the diseases. Method Fifty children with chest wall lesions confirmed by surgery and pathology were enrolled from October 2009 to June 2018 into this study. The 50 cases included 4 infectious lesions and 46 non-infectious lesions which was composed of benign tumors and malignant tumors. All patients underwent US, chest CT and MRI. Clinical data and imaging findings were retrospectively analyzed, and relevant literatures were reviewed. Results There were obvious difference in clinical and imaging findings among three groups（infection, benign tumor, and malignant tumor）. 1. Clinical finding： all infectious cases presented fever, chest pain, and local redness, swelling, and heat. All the infectious lesions were soft, 37 of 41（90.2%） benign tumors were soft, and all the malignant tumors were firm. The lesions presented a limited mobility in all the groups. Local tenderness was presented in all the infection and malignant tumor groups. However, in the benign tumor group, local tenderness was presented in 3 of 41 cases（7.3%）,which was significantly lower than in the other groups. 2. Imaging finding： in the benign tumor group, lesions showed heterogeneous density in 31 cases and well-defined margin in 27 cases. The incidences were 75.6%（31/41） and 65.9%（27/41）, respectively. However, in the infection and malignant tumor groups, all the lesions appeared heterogeneous density and indistinct margin. In the benign tumor group,there were 4 cases presented calcification（9.8%）, 1 hemorrhage（2.4%） and 8 cystic spaces（19.5%）. Rib destruction was found in 6 of 41 cases（14.6%） in the benign tumor group. All malignant tumors showed rid destruction, and the lesions even involved thoracic cavity. No rib damage was found in the infection group. Lesions showed obvious enhancement in all the infection and malignant tumor groups, but non-enhancement to mild enhancement was observed

关 键 词：儿童 胸壁病变 超声 体层摄影术 X线计算机 磁共振成像 

分 类 号：R734.4[医药卫生—肿瘤] R445[医药卫生—临床医学]