摘要
目的 探讨儿童血液病异基因造血干细胞移植(allo-HSCT)后胸部异常积气的影像学特征分析。方法 选取19例儿童血液病allo-HSCT后胸部异常积气患儿,其中急性淋巴细胞白血病(ALL)7例,急性髓系白血病(AML)7例,T淋巴母细胞淋巴瘤(T-LBL)1例,再生障碍性贫血(AA)3例,Shwachman-Diamond综合征(舒-戴综合征)1例。19例中2例发现肠壁积气(PI)后行腹部CT平扫。根据积气病因不同将病例分为两组,即闭塞性细支气管炎综合征(BOS)组、非闭塞性细支气管炎综合征(非BOS)组,BOS组11例气漏病因均为BOS,非BOS组8例,包括肠壁积气(PI)2例、肺部感染2例、口咽部感染1例及气漏病因不明者3例。影像学表现包括纵隔气肿(PM)、间质气肿(PIE)、肺气囊、气胸、胸膜外间隙积气、椎管内积气及皮下气肿,将出现一项影像学表现的归类为单一型气漏,将出现至少两项影像学表现的归类为混合型气漏,采用SPSS 22.0软件比较两组影像学特征的差异。结果 BOS主要表现为双肺空气潴留征、多发支气管囊、柱状扩张及管壁增厚等,11例患儿均为混合型气漏,且均伴纵隔气肿,其中5例伴有皮下气肿。7例伴有PIE,4例为支气管血管束周围型PIE,3例为小叶间隔旁型PIE。5例出现一侧气胸,影像学表现为胸腔内条带状气体影,邻近肺组织受压。5例出现胸膜外间隙积气,影像学表现为胸膜外脂肪间隙弧形带状气体影,局部伴小分隔,其中1例(1/5)伴有椎管内积气,表现为椎管内条状气体影。非BOS组中2例为混合型气漏,6例为单一型气漏,其中2例PI患儿影像学表现为结肠壁内多发囊状气体影环绕,伴腹腔内多发游离气体影。2例肺内感染患儿中1例出现少量纵隔气肿,另1例出现一侧气胸。3例气漏病因不明者中1例为混合型气漏,出现纵隔气肿、间质气肿、气胸及椎管内积气等多种表现,另2例仅见少量纵隔气肿。1例纵隔气肿MRI平扫及增强扫描见上纵隔囊状长T_(1)WI、长T_(2)WI信号,DWI见小片状高信号,增强后病变呈环形强化。非BOS组未出现肺气囊及胸膜外间隙积气。BOS组7例出现PIE,非BOS组1例出现PIE,两组PIE发生率比较差异有统计学意义(P<0.05)。BOS组5例出现胸膜外间隙积气,非BOS组未出现此征象,两组比较差异有统计学意义(P<0.05)。BOS组11例均为混合型气漏,非BOS组2例为混合型气漏,两组比较差异有统计学意义(P<0.05)。而在纵隔气肿、肺气囊、气胸、椎管积气及皮下气肿等胸部气漏征象方面,两组比较差异无统计学意义(P>0.05)。结论 儿童allo-HSCT后胸部异常积气可能源于多种不同病因,相较于其他病因,BOS并发ALS的气漏表现更具多样性,间质气肿及胸膜外间隙积气更能提示BOS发生。
Objective To investigate the imaging manifestations of abnormal chest air accumulation after allogeneic hematopoietic stem cell transplantation(allo-HSCT)in children with hematopathy.Methods Imaging findings of 19 children with allo-HSCT complicated with abnormal chest air accumulation were retrospectively analyzed,including 7 cases of acute lymphoblastic leukemia(ALL),7 cases of acute myeloid leukemia(AML),1 case of T-lymphoblastic lymphoma(T-LBL),3 cases of aplastic anemia(AA),and 1 case of Shwachman-Diamond syndrome.Of those 19 patients,2 patients were found to pneumatosis intestinalis(PI)and then underwent abdominal CT plain scan.Those cases were divided into 2 groups according to the different causes of air leakage,namely,BOS group and non-BOS group.11 cases in BOS group were all caused by air leakage,and 8 cases in non-BOS group were caused by air leakage,including 2 cases of pneumatosis intestinalis(PI),2 cases of pulmonary infection,1 case of oropharyngeal infection,and 3 cases with unknown causes of air leakage.The imaging manifestations included pneumomediastinum(PM),pulmonary interstitial emphysema(PIE),pulmonary balloon,pneumothorax,air accumulation in the extrapleural space,pneumorrhachis,and subcutaneous emphysema.Those with one imaging manifestation were classified as single air leak,and those with at least two imaging manifestations were classified as mixed air leak.SPSS 22.0 software was used for data analysis.P<0.05 was considered to be statistically significant.Results BOS mainly manifested as bilateral lung air trapping sign,multiple bronchial cysts,columnar dilation and thickening of the lumen wall,etc.Among the 11 patients,all were of mixed type air leakage,and all were accompanied by mediastinal emphysema,among which 5 cases were accompanied by subcutaneous emphysema.7 cases were accompanied by PIE,4 cases were of peripheral type PIE around bronchovascular bundles,3 cases were of peripheral type PIE beside the lobar septa,5 cases had unilateral pneumothorax,and the imaging manifestations were strip-like gas shadows in the thoracic cavity,with compression of adjacent lung tissue.5 cases had extrapleural air accumulation,and the imaging manifestations were arc-shaped band-like gas shadows in the pleural fat space,with local small septa,among which 1 case(1/5)was accompanied by intraspinal air accumulation,manifested as strip-like gas shadows in the spinal canal.In the non-BOS group,2 cases were of mixed type air leakage,6 cases were of single type air leakage.Among them,2 cases of PIE had multiple cystic gas shadows around the colon wall and multiple free gas shadows in the abdominal cavity.Among the 2 cases of pulmonary infection patients,1 case had a small amount of mediastinal emphysema,and the other 1 case had unilateral pneumothorax.Among the 3 cases of unknown cause of air leakage,1 case was of mixed type air leakage,presenting multiple manifestations such as mediastinal emphysema,interstitial emphysema,pneumothorax and intraspinal air accumulation,and the other 2 cases only had a small amount of mediastinal emphysema.1 case of mediastinal emphysema originated MRI plain scan and enhanced scan showed cystic long T1WI and long T2WI signals in the upper mediastinum,and small patchy high signals after enhancement,and the lesion showed ring-like enhancement after enhancement.In the non-BOS group,no pulmonary air cysts or extrapleural air accumulation were found.In the BOS group,7 cases had PIE,and in the non-BOS group,1 case had PIE.The difference between the two groups was statistically significant(P<0.05).In the BOS group,5 cases had extrapleural air accumulation,and no such sign was found in the non-BOS group,and the difference was statistically significant(P<0.05).In the BOS group,11 cases were of mixed type air leakage,and 2 cases were of mixed type air leakage in the non-BOS group.The difference between the two groups was statistically significant(P<0.05).There was no statistically significant difference in mediastinal emphysema,pulmonary air cysts,pneumothorax,intraspinal air accumulation and subcutaneous emphysema between the two groups(P>0.05).Conclusion Abnormal chest air accumulation after allo-HSCT in children may be due to various causes.Compared with other causes,the air leakage manifestations of BOS complicated with ALS are more diverse,and interstitial emphysema and air accumulation in the extrapleural space can better indicate the occurrence of BOS.
作者
李连波
石玉铸
李丽
邱珂
LI Lianbo;SHI Yuzhu;LI Li;QIU Ke(Department of Imaging,Hebei Yanda Ludaopei Hospital,Sanhe 065201,China;Department of Imaging,Beijing Ludaopei Hospital,Beijing 100176,China)
出处
《医学影像学杂志》
2025年第7期63-68,共6页
Journal of Medical Imaging
基金
河北省医学科学研究课题(编号:20232043)。
关键词
血液病
造血干细胞移植
气漏综合征
肠壁积气
感染
磁共振成像
体层摄影术
X线计算机
Hematopathy
Hematopoietic stem cell transplantation
Air leakage syndrome
Pneumatosis intestinalis
Infection
Magnetic resonance imaging
Tomography,X-ray computed
