儿童感染性肺动脉假性动脉瘤3例并文献复习  

Infectious pulmonary artery pseudoaneurysm in 3 children and literatures review

作　　者：吕莹[1] 王雪儿 田代印[2] Lyu Ying;Wang Xueer;Tian Daiyin(Department of Radiology,Children′s Hospital of Chongqing Medical University,National Clinical Research Center for Child Health and Disorders,Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity,Chongqing 400014,China;Department of Respiratory Disease,Children′s Hospital of Chongqing Medical University,National Clinical Research Center for Child Health and Disorders,Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity,Chongqing 400014,China;Department of Pediatric,the First Affiliated Hospital of Airforce Medical University,Xi'an 710032,China)

机构地区：[1]重庆医科大学附属儿童医院放射科、国家儿童健康与疾病临床医学研究中心、儿童发育疾病研究教育部重点实验室、儿童感染与免疫罕见病重庆市重点实验室,重庆400014 [2]重庆医科大学附属儿童医院呼吸科、国家儿童健康与疾病临床医学研究中心、儿童发育疾病研究教育部重点实验室、儿童感染与免疫罕见病重庆市重点实验室,重庆400014 [3]空军军医大学第一附属医院儿科,西安710032

出　　处：《中华儿科杂志》2025年第4期367-372,共6页Chinese Journal of Pediatrics

摘　　要：目的总结儿童感染性肺动脉假性动脉瘤(IPAP)的临床特征及预后。方法病例系列研究,总结重庆医科大学附属儿童医院2015年1月至2024年12月诊治的3例IPAP患儿的临床资料。分别以"感染""肺动脉假性动脉瘤""infect""pseudoaneurysm""pulmonary artery"为关键词检索中国知网、万方数据库、维普中文期刊、中华医学期刊全文数据库及PubMed数据库建库至2024年12月的文献,总结IPAP的临床特征及预后。结果3例患儿分别为2月龄男婴、6岁3月龄男童及12岁女童,均有发热伴不同呼吸道症状。例1合并右眼球后脓肿,例2既往确诊慢性肉芽肿病、银屑病,例3既往诊断动脉导管未闭。3例患儿均通过增强CT诊断为多发IPAP,肺部感染灶相关型2例,感染性心内膜炎相关型IPAP 1例,合并胸腔积液3例、坏死性肺炎2例和肺栓塞1例。3例患儿经抗感染治疗,2例好转,1例死亡。共检索到符合条件的中文文献0篇,英文文献9篇,结合本组3例共12例IPAP患儿。临床表现常见发热10例、咳嗽6例、咯血5例。最常见的病原体为耐甲氧西林金黄色葡萄球菌3例。合并肺外感染灶6例,有先天性心脏病史并手术治疗4例,行直肠前庭瘘管修复术1例,合并免疫功能异常4例。12例IPAP患儿根据影像特征分为肺部感染灶相关型IPAP 9例,感染性心内膜炎相关型IPAP 1例,因影像资料不全无法准确分型2例。7例为单发IPAP,其中3例主要位于右肺下叶;5例为多发IPAP。IPAP合并胸腔积液8例、合并坏死性肺炎8例(其中1例可疑)、合并肺脓肿及肺栓塞各3例。12例患儿中有5例以抗感染治疗,未经历肺叶切除术及血管栓塞治疗,其中3例好转,治疗无效1例,死亡1例。6例患儿行血管栓塞,其中4例好转,2例死亡。1例行肺叶切除术后康复出院。结论儿童IPAP的临床表现多样,常伴肺外感染及免疫异常,增强CT在诊断中具有重要作用。IPAP的预后与治疗方式密切相关,及时诊�Objective To summarize the clinical characteristics and prognosis of infectious pulmonary artery pseudoaneurysm(IPAP)in pediatric patients.Methods This case series study summarizes the clinical data of 3 children diagnosed with IPAP at the Children′s Hospital of Chongqing Medical University from January 2015 to December 2024.A comprehensive literature review was conducted by searching Chinese databases(China National Knowledge Infrastructure,Wanfang Data Knowledge Service Platform,China VIP Database and Chinese Medical Journals Full Text Database)and the PubMed database through December 2024,using the keywords"infect""pseudoaneurysm""pulmonary artery".The clinical characteristics and prognosis of IPAP were synthesized by combining the reviewed literature.Results The 3 cases included a 2-month-old male infant,a 6-year-3-month-old male child and a 12-year-old female child,all of whom presented with fever and various respiratory symptoms.Case 1 was complicated by a retro-orbital abscess,Case 2 had a history of chronic granulomatous disease and psoriasis,and Case 3 was diagnosed with patent ductus arteriosus.Enhanced CT imaging in all 3 cases revealed multiple IPAP,with 2 cases associated with pulmonary infection foci and 1 case linked to infective endocarditis.Accompanying complications included pleural effusion in all 3 cases,necrotizing pneumonia in 2 cases,and pulmonary embolism in 1 case.Of the 3 cases,2 cases showed improvement after anti-infective treatment,while 1 case resulted in death.A total of 9 English-language studies were identified,while no suitable Chinese-language studies were found.Including these 3 cases,a total of 12 pediatric IPAP cases were analyzed.The predominant clinical manifestations included fever in 10 cases,cough in 6 cases and hemoptysis in 5 cases.The most frequently identified pathogen was methicillin-resistant Staphylococcus aureus found in 3 cases.Additionally,6 cases were complicated by extra-pulmonary infections,4 cases had a history of congenital heart disease and surgical int

关 键 词：肺动脉 动脉瘤 假性 感染 儿童 

分 类 号：R725.6[医药卫生—儿科]