一滴水 发表于 2012-4-23 12:12:11

新生儿肺炎(Neonatal Pneumonia)胸片病例点评



C A S E 1 4病例14

1. What are the imaging findings in this neonate with respiratory distress?
1.该呼吸窘迫新生儿的影像学表现是什么?

2. What is the differential diagnosis?
2.鉴别诊断有哪些?

3. What are the possible complications?
3.可能的并发症有哪些?

4. What are the predisposing factors?
4.本病的诱因有哪些?

一滴水 发表于 2012-4-23 12:12:29

Diagnosis: Neonatal Pneumonia
诊断:新生儿肺炎

1. Frontal radiograph of the chest demonstrates bilateral patchy interstitial markings in minimally hyperexpanded lungs. Of note, an umbilical artery catheter is seen, with the tip projecting over the T3/4
interspace.
1.正位片示双肺稍过度充气,双肺可见斑片状间质纹理。值得注意的是,可见脐动脉导管尖端位于T3/4椎间隙水平。

2. Differential diagnosis of these findings includes surfactant deficiency disease, neonatal pneumonia,
transient tachypnea of the newborn, and meconium aspiration.
2.本病的鉴别诊断包括:表面活性物质缺乏症、新生儿肺炎、新生儿暂时性呼吸急促、胎粪吸入。

3. Complications of neonatal pneumonia include pleural effusion, empyema, abscess, and
pneumatocele formation.
3. 新生儿肺炎的并发症有:胸腔积液、脓胸、肺脓肿、肺大泡形成。

4. Factors that predispose to neonatal pneumonia include prolonged premature rupture of membranes,
maternal ascending infection, placental infection, and perineal contamination.
4. 新生儿肺炎的易患因素有:长时间胎膜早破、孕母上行性感染、胎盘感染、会阴污染。

Reference参考文献
Swischuk LE: Imaging of the newborn, infant and
young child, ed 5, Philadelphia, 2004, Lippincott
Williams & Wilkins, pp 43–46.

Cross-Reference相关参考文献
Blickman JG, Parker BR, Barnes PD: Pediatric radiology—
the requisites, ed 3, Philadelphia, 2009, Mosby,
pp 30–31.

Comments点评
Neonatal pneumonia is most often bacterial (Streptococcus, Staphylococcus aureus, and Escherichia coli) but
may be viral (adenovirus, herpes simplex, influenza, and parainfluenza). Nonspecific findings are seen on
chest radiograph, with hyperexpansion and diffuse increase in interstitial markings most common. Perihilar
streaky densities and diffuse haziness favors viral infectionCoarse, patchy parenchymal infiltrates favor bacterial
infection. Frank consolidation is rare in neonatesPleural effusion may accompany bacterial pneumonia.
Infection with group B streptococci may mimic surfactant deficiency disease with granularity, perhaps more
prominent in the lower lobes.
新生儿肺炎多为细菌感染所致(链球菌、金黄色葡萄球菌、大肠杆菌),但亦可为病毒感染(腺病毒、单纯疱疹病毒、流感和副流感病毒)。胸片表现无特异性,最常表现为双肺过度充气、弥漫性间质纹理。肺门周围纹状高密度影以及弥漫性模糊影提示病毒感染;粗大的斑片状肺实质浸润则提示细菌感染。大片状实变罕见。细菌性肺炎可伴有胸腔积液。B型链球菌感染的影像学表现可类似于表面活性物质缺乏症:双肺粟粒状阴影,可能以双下叶为著。

Most commonly, the infant is infected in utero or during passage through the birth canal. Infants typically
present with respiratory distress in the first 48 hours of life. Predisposing factors include prolonged premature
rupture of the membranes, ascending infection from the vagina, placental infection, and contamination
from a poorly prepared perineum or maternal fecal material. Long-term complications include chronic lung
disease.
婴儿最见于宫内或产道内感染,一般于48小时内出现呼吸窘迫。其易患因素有:长时间胎膜早破、经阴道上行性感染、胎盘感染、清洁准备不佳或孕母粪便导致的会阴污染。新生儿肺炎的远期并发症为慢性肺病。

Delayed onset of right diaphragmatic hernia has been recognized as a complication, especially with group B
streptococci infections. Other complications include empyema, abscess, and pneumatoceles.
据认为,迟发型右侧膈疝也是本病的并发症之一,尤其是B型链球菌感染者。其它并发症还有:脓胸、肺脓肿、肺大泡形成。

chinanyd 发表于 2012-4-23 21:17:29

学习了,谢谢斑竹。

山谷幽兰 发表于 2012-4-26 23:44:50

学习来了,谢谢分享的好病例

山谷幽兰 发表于 2012-4-26 23:44:56

学习来了,谢谢分享的好病例

SHAMO1111 发表于 2012-5-12 09:48:58

学习了 谢谢分享
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