一滴水 发表于 2012-4-23 12:05:58

会厌炎X线病例点评



1. What are the findings in this young adult?
1.该年轻人的影像学表现是什么?
2. How will the patient present?
2.该患者的临床表现是什么?
3. What age group is most likely to be affected?
3.本病最好发年龄是什么?
4. Are there any special considerations in the imaging of this kind of patient?
4.在对此种患者行影像学检查时,有何特别考虑?

一滴水 发表于 2012-4-23 12:06:39

Diagnosis: Epiglottitis 诊断:会厌炎
1. The epiglottis is enlarged; the swelling extends to the aryepiglottic folds. The vallecular airspace is not seen because of the extensive pharyngeal swelling.
1.会厌增大;肿胀延伸至杓会厌襞。由于咽部广泛肿胀,会厌谷不能显示。
2. Usually high fever, drooling, dysphasia, and respiratory distress.
2.常见高热、流涎、言语困难、呼吸窘迫。
3. Between 3 and 6 years old.
3.3-6岁之间。
4. If epiglottitis is present, a possibility exists that the patient will need urgent intubation or tracheostomy. A radiograph should be obtained (ideally by personnel nearby who can do so portably in the patient care area).
4.如患有会厌炎,患儿可能需要紧急行气管插管或气管造口术。故摄片时,最好有能行气管插管或气管造口术的医务人员在附近。

Reference参考文献
Kuhn JP, Slovis TL, Haller JO: Caffey’s pediatric diagnostic imaging, ed 10, Philadelphia, 2004, Mosby, p 811.

Cross-Reference相关参考文献
Blickman JG, Parker BR, Barnes PD: Pediatric radiology— the requisites, ed 3, Philadelphia, 2009, Mosby, pp 10–12.

Comment点评
Common infectious causes of upper respiratory symptoms in childhood include epiglottitis, croup and/or tracheitis, and retropharyngeal abscess. Epiglottitis is usually caused by Haemophilus influenzae type B (HIB), which is much less common now that immunization against HIB is routine. 导致小儿上呼吸道症状的常见感染性疾病包括会厌炎、哮吼和/或气管炎、咽后脓肿。会厌炎常由B型流感嗜血杆菌(HIB)引起,但自从常规对HIB行免疫治疗以来,会厌炎已远不如以前常见。Differentiation from the other causes of upper respiratory infection in part is determined by the clinical setting. Croup is often seen in a younger patient, 6 months to 3 years old; it is a viral illness and fever is usually not as high as in epiglottitis. Tracheitis is less common and has more extensive involvement of the trachea compared with croup. It is usually of bacterial origin and is seen in the same age group as croup. Retropharyngeal abscess may be a complication of bacterial tonsillitis, and clinical findings of tonsillar infection may be present. This illness can be seen in infants younger than 6 months old. 鉴别会厌炎与其它上呼吸道感染,须结合临床。哮吼常见于较小的婴儿,年龄6个月-3岁;哮吼系由病毒感染所致,故发热程度不如会厌炎高。气管炎较少见,气管受累及的范围较哮吼广,常由细菌感染所致,好发年龄与哮吼一致。咽后脓肿可继发于细菌性扁桃体炎,患儿可有扁桃体感染的临床表现。咽后脓肿可见于6个月以下的婴幼儿。If imaging is needed, anteroposterior (AP) and lateral views of the neck are necessary. The AP view is most important in the identification of the subglottic narrowing seen in croup. If findings point toward retropharyngeal abscess, contrast-enhanced computerized tomography is usually performed. In 25% of patients with epiglottitis, subglottic narrowing consistent with edema is also present. Causes of epiglottic enlargement other than infection are angioneurotic edema, aryepiglottic or epiglottic cyst, hemophilia (hemorrhage), and thermal injury sometimes
seen in child abuse. 如需行影像学检查,须行颈部前后位和侧位摄片。前后位片对于显示哮吼的声门下狭窄最为重要。如平片提示咽后脓肿,常需行CT增强扫描。25%的会厌炎患儿可见声门下狭窄,提示声门下水肿。导致会厌增大的非感染性病因有:血管神经性水肿、杓会厌囊肿或会厌囊肿、血友病(出血)、有时见于虐婴的热损伤。

CRXCT 发表于 2012-5-9 22:55:31

3-6岁之间.常见高热、流涎、言语困难、呼吸窘迫,影像上见会厌增大;肿胀延伸至杓会厌襞。由于咽部广泛肿胀,会厌谷不能显示.
学习啦:会厌炎
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