一滴水 发表于 2012-4-23 12:09:43

小儿间质性肺气肿(Pulmonary Interstitial Emphysema)胸片病例点评





C A S E 7病例7

1. This patient had these three sequential films (first, second, and third figures) within a 24-hour period. What patient group accounts for the largest proportion of these cases?
1.此3张连续平片(图1、2、3)摄于24小时内。本病患者多属于哪一类人群?

2. What plain film finding may precede the development of this abnormality?
2.在出现本病前,平片有何发现?

3. What complications do you look for?
3.阅片时须观察有无何种并发症?

4. What lung pathologic conditions promote this abnormality?
4.什么肺部疾患易导致本病?

一滴水 发表于 2012-4-23 12:10:04

Diagnosis: Pulmonary Interstitial Emphysema
诊断:间质性肺气肿
1. Premature infants (however, it can happen in any patient in whom airway pressures exceed the integrity of the airway epithelium).
1.本病患者多为早产儿(亦可见于任何气道压力超出维持气道上皮完整的压力上限的患者)。
2. Hyperinflation with endotracheal tube in place.
2.气管内导管位置正常、过度充气。
3. Pneumatoceles, pneumothorax, pneumomediastinum, pneumoperitoneum.
3.肺气囊、气胸、纵膈气肿、气腹。
4. Surfactant deficiency, neonatal pneumonia, meconium aspiration, persistent pulmonary hypertension.
4.肺泡表面活性物质缺乏症、新生儿肺炎、胎粪吸入、持续性肺动脉高压。

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, pp 28–29.

Comment点评
The lungs of a premature infant are stiff and noncompliant. This is due to lack of surfactant, normally produced by type II alveolar cells, beginning in week 24 of gestation and usually complete by week 32. 由于缺乏II型肺泡细胞产生的表面活性物质,早产儿的肺僵硬,且顺应相差。II型肺泡细胞于孕24周开始发育,于孕32周发育完全。Without this protein, alveolar distension and adequate oxygenation must be maintained by high-pressure ventilation with oxygen-rich air. This combination injures the already fragile alveolar walls and allows air to leak between the lining cells into the interstitial spaces and lymphatics. 由于缺乏肺泡表面活性物质,需通过富氧空气进行高压换气方可维持肺泡的正常扩张与氧和。富氧空气和高压换气损伤了本就脆弱的肺泡壁,使得空气由肺泡内衬细胞间逸出进入间质间隙和淋巴系统。The air is first visible lying parallel to the bronchi, forming characteristic lucent lines and dots. Movement
of the lungs with respiration causes the air to change
configuration. It can dissect centrally or peripherally,
causing pneumomediastinum and pneumothorax, or it
can become centrally confluent, creating a pneumatocele.
Air in the mediastinum can dissect downward through
the inferior pulmonary ligaments and result in sterile
pneumoperitoneum.间质内空气首先表现为特征性的平行于支气管的线状和点状透亮影。该影的形态随呼吸运动而改变。间质内空气可向中央或外周逸出,导致纵膈积气或气胸,亦可于中央融合,形成肺气囊。间质内空气还可通过下肺韧带向下逸出进入腹腔,形成无菌性气腹。

Aggressive treatment with exogenous surfactant in the delivery room can decrease the severity of the lung disease and avert this complication. Once present, it is treated by decreasing ventilatory pressures. Jet ventilation allows greater control of airway pressures. If unilateral, decubitus positioning onto the affected lung can effectively decrease pressure locally and hasten healing. Pneumatoceles occasionally must be surgically removed if they become intractably large. Chest radiographs, which are a valuable monitor for this disease, can alert clinicians to dangerous levels of hyperinflation that could precipitate air leaks, enabling diagnosis of the emphysema and its complications and determining efficacy of therapeutic measures.
于产房内积极给予外源性肺泡表面活性物质可减轻肺部损伤,从而避免出现间质性肺气肿。一旦出现,则应降低换气压力。喷射通气可较好地控制气道内压力。如间质性肺气肿仅累及一侧,保持患侧卧位可有效降低局部气压,从而有助于恢复。偶有肺气囊难以控制而需手术切除者。胸片可提醒临床医生避免因气压过高导致过度充气造成气体外溢,还可诊断肺气肿及其并发症,并且可观察疗效,故对于本病的监控很有价值。

苏离 发表于 2012-4-26 15:18:30

学习学习了

山谷幽兰 发表于 2012-4-26 23:51:46

学习了,受益

太阳和月亮 发表于 2014-5-28 09:41:02

学无止境,法宜穷追不舍

轻云飞扬 发表于 2015-7-1 18:41:27

好资料,学习了,谢谢分享。
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