一滴水 发表于 2012-4-23 12:03:33

小儿哮吼(Croup)病例点评

本帖最后由 一滴水 于 2012-4-23 12:04

1. What are the imaging findings in this 13-month-old child with a “barking” cough?
1. 患儿,1岁1个月,犬吠样咳嗽。该患儿的影像学表现是什么?

2. If you watched this child breathe under fluoroscopy, what would you notice?
2.如在透视下观察该患儿的呼吸运动,需要注意观察什么?

3. What other things would the fluoroscopy help you to exclude if the plain films were not conclusive?
3.如平片不能确诊,透视下的哪些征象可帮助排除本病?

一滴水 发表于 2012-4-23 12:03:55

Diagnosis: Croup诊断:哮吼
1. Subglottic narrowing, normal epiglottis, and aryepiglottic folds.
1.声门下狭窄、会厌、杓会厌襞正常
2. Pharynx overdistends on inspiration; subglottic narrowing more obvious on expiration (as normal lower trachea distends against the obstruction); narrowed segment appears rigid.
2.吸气时,咽部过度扩张;呼气相,声门下狭窄更加明显(气管下部正常扩张,故对比更明显);狭窄段僵硬。
3. Congenital subglottic stenosis or subglottic hemangioma (narrowing might be more rigid or asymmetric); airway or esophageal foreign body (subtle radiodensity or tracheal shift may be evident on an oblique or magnified view); false-positive plain films (forceful inspiration can cause subglottic collapse; observation of respiratory cycles shows normal tracheal wall mobility).
3.先天性声门下狭窄或声门下血管瘤(狭窄段可能更僵硬或不对称);气道或食管异物(异物所致之稍高密度影或气管轻度移位可能在斜位或放大影像上更明显);假阳性(用力吸气可引起声门下狭窄;通过观察整个呼吸周期可见气管壁活动正常)。

Reference 参考文献
Kuhn JP, Slovis TL, Haller JO: Caffey’s pediatric diagnostic imaging, ed 10, Philadelphia, 2004, Mosby, p 814.

Cross-Reference 相关参考文献
Blickman JG, Parker BR, Barnes PD: Pediatric radiology— the requisites, ed 3, Philadelphia, 2009, Mosby.

Comment 点评
Symptoms connected with viral laryngotracheobronchitis peak in the 3-month to 3-year age range. Usually intercurrent upper respiratory infection exists. Since the advent of vaccines against Haemophilus influenzae, epiglottitis has ceased to be the main clinical masquerader. Pulmonary edema is a rare acute complication.
病毒性喉气管支气管炎的相关症状于3个月-3岁之间最为明显,常合并有上呼吸道感染。自流感嗜血杆菌疫苗出现以来,会厌炎已不再成为哮吼的主要鉴别诊断。肺水肿是本病的少见急性并发症。
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