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目的总结儿童重症手足口病影像表现及临床意义。方法对2009年3月至5月在郑州市儿童医院住院并确诊的重症手足口病患儿35例,对其胸部X线平片,胸部CT,脑部CT的影像表现进行回顾性分析。结果早期胸部X线表现为肺纹理增粗13例,两肺渗出性改变(肺水肿)20例,肺炎2例。晚期以渗出性改变为主,合并肺不张5例,合并ARDS4例,合并气胸及纵隔气肿皮下气肿2例,合并机遇感染2例。15例行胸部CT扫描检查,肺炎伴大片实变4例,渗出性改变6例,肺炎5例,其中合并胸腔积液3例,合并胸膜增厚2例。26例进行头颅SCT扫描检查,早期:22例表现正常,脑水肿2例,多发软化灶2例;晚期脑萎缩9例,脑干脑炎3例,水肿1例,蛛网膜下腔增宽3例,合并脑疝、脑出血1例。肺部病变出现早,变化快,发病后2d～4 d达到高峰,重症儿童肺部反复出现肺水肿。肺部改变与临床表现基本一致。脑部影像改变晚于肺部影像改变。结论 HFMD的胸部X线、CT表现可反映其病情变化,对了解病情、指导治疗及预后判断具有重要意义,反复肺水肿提示预后不良。
Objective To summarize the imaging findings and clinical significance of severe hand-foot-mouth disease in children. Methods From March to May 2009, 35 children with severe hand-foot-mouth disease who were hospitalized and diagnosed in Children’s Hospital of Zhengzhou City were retrospectively analyzed in their chest X-ray, chest CT and brain CT. Results Early chest X-ray showed thickened lung texture in 13 cases, two lung exudative changes (pulmonary edema) in 20 cases, 2 cases of pneumonia. Late exudative changes, combined atelectasis in 5 cases, 4 cases of ARDS merger, combined pneumothorax and mediastinal emphysema subcutaneous emphysema in 2 cases, combined with chance of infection in 2 cases. Thoracic CT scan of 15 cases, pneumonia with large consolidation in 4 cases, exudative changes in 6 cases, 5 cases of pneumonia, including pleural effusion in 3 cases, combined pleural thickening in 2 cases. Twenty-six patients underwent SCT scans. In the early stage, 22 cases showed normal brain edema in 2 cases and multiple softening lesions in 2 cases. 9 cases had advanced brain atrophy, 3 cases had encephalic encephalitis, 1 case had edema and 3 cases had subarachnoid space widened. Cases, merger hernia, cerebral hemorrhage in 1 case. Lung lesions appear early, rapid change, peak 2d ~ 4d after onset, recurrent pulmonary edema in the lungs of critically ill children. Lung changes and clinical manifestations are basically the same. Brain image changes later than lung image changes. Conclusion The chest X-ray and CT findings of HFMD can reflect the changes of the disease, which is of great significance for understanding the disease, guiding the treatment and prognosis. Recurrent pulmonary edema indicates the poor prognosis.