Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10467, USA.
AJR Am J Roentgenol. 2009 Dec;193(6):1648-54. doi: 10.2214/AJR.09.2791.
The purpose of our study was to compare chest ultrasound and chest CT in children with complicated pneumonia and parapneumonic effusion.
We retrospectively compared chest ultrasound and chest CT in 19 children (nine girls and 10 boys; age range, 8 months-17 years) admitted with complicated pneumonia and parapneumonic effusion between December 2006 and January 2009. Images were evaluated for effusion, loculation, fibrin strands, parenchymal consolidation, necrosis, and abscess. In the subset of patients who underwent surgical management, imaging findings were correlated with operative findings.
Eighteen of 19 patients had an effusion on both chest ultrasound and chest CT. The findings of effusion loculation as well as parenchymal consolidation and necrosis or abscess were similar between the two techniques. Chest ultrasound was better able to visualize fibrin strands within the effusions. Of the 14 patients who underwent video-assisted thoracoscopy, five had surgically proven parenchymal abscess or necrosis. Preoperatively, chest ultrasound was able to show parenchymal abscess or necrosis in four patients, whereas chest CT was able to show parenchymal abscess or necrosis in three.
In our series, chest ultrasound and chest CT were similar in their ability to detect loculated effusion and lung necrosis or abscess resulting from complicated pneumonia. Chest CT did not provide any additional clinically useful information that was not also seen on chest ultrasound. We suggest that the imaging workup of complicated pediatric pneumonia include chest radiography and chest ultrasound, reserving chest CT for cases in which the chest ultrasound is technically limited or discrepant with the clinical findings.
我们的研究目的是比较复杂性肺炎伴脓胸儿童的胸部超声和胸部 CT。
我们回顾性比较了 2006 年 12 月至 2009 年 1 月期间因复杂性肺炎伴脓胸住院的 19 名儿童（9 名女孩和 10 名男孩；年龄 8 个月至 17 岁）的胸部超声和胸部 CT。评估了积液、分隔、纤维束、肺实质实变、坏死和脓肿。在接受手术治疗的患者亚组中，将影像学表现与手术发现进行了比较。
19 例患者中有 18 例在胸部超声和胸部 CT 上均有积液。两种技术对积液分隔以及肺实质实变、坏死或脓肿的发现相似。胸部超声更能显示积液内的纤维束。在 14 例行电视辅助胸腔镜检查的患者中，5 例有经证实的肺实质脓肿或坏死。术前，胸部超声能显示 4 例肺实质脓肿或坏死，而胸部 CT 能显示 3 例。
在我们的系列中，胸部超声和胸部 CT 在检测复杂性肺炎引起的局限性积液和肺坏死或脓肿方面具有相似的能力。胸部 CT 没有提供任何与胸部超声不一致的、额外的临床有用信息。我们建议，复杂性儿童肺炎的影像学检查包括胸部 X 线摄影和胸部超声，仅在胸部超声技术受限或与临床发现不一致的情况下，才进行胸部 CT 检查。
