Boloursaz Mohmmad Reza, Khalilzadeh Soheila, Baghaie Nooshin, Khodayari Amir Ali, Velayati Ali Akbar
National Research Institute of Tuberculosis and Lung Disease, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
Acta Med Iran. 2010 Jul-Aug;48(4):244-9.
Despite the extensive preventive and therapeutic measures present against tuberculosis (TB), this disease still remains as one of the important causes of mortality and morbidity in the world. Considering the high incidence of TB in children, rareness of its' clinical features and complexity of bacteriologic diagnosis in this age group paraclinical studies, especially radiologic evaluations, is useful for reaching a final diagnosis. This 5 year study was conducted in National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Massih Daneshvari Hospital, Tehran, Iran. This retrospective study was conducted on 70 children (43 (61%) female and 27 (38.5%) male) aged between 5 months to 15 years old during a five year period (from 2001-2006) in pediatric ward. It was performed on children who were confirmed to have TB by various clinical, bacteriologic and radiologic features and tuberculin skin test. We studied the radiologic features of pulmonary TB in these children. Right lung involvement was observed in 65%, left lung 23% and bilateral involvement was detected in 12%. Also middle and superior lobes were the most common lobes affected. The commonest radiographic feature was hilar (mediastinal) lymphadenopathy; 70% detected on chest x-ray (CXR) and 85% on CT scan. Lymph nodes on right side were affected more; 25% were calcified. Also nodular infiltration of lung parenchyma was observed in 35% of CXRS and 61% of CT scans. This was followed by patchy consolidation detected in 25% and 35% of CXRs and CT scans respectively. We also observed that children <3 yr. of age had the highest lymph node involvement but the least parenchymal lesions as compared to older children. It is concluded that primary TB is the most common form of pulmonary TB in children. This could be in the form of hilar lymphadenopathy with or without lung parenchymal involvement. Also radiologic features could provide valuable information in regard to diagnosis, treatment and follow-up of pulmonary TB in children.
尽管目前针对结核病（TB）有广泛的预防和治疗措施，但该疾病仍是全球重要的死亡和发病原因之一。鉴于儿童结核病的高发病率、其临床特征的罕见性以及该年龄组细菌学诊断的复杂性，辅助临床研究，尤其是放射学评估，对于最终诊断很有帮助。这项为期5年的研究在伊朗德黑兰马西赫·达内什瓦里医院的国家结核病和肺部疾病研究所（NRITLD）进行。这项回顾性研究在儿科病房对70名年龄在5个月至15岁之间的儿童（43名（61%）女性和27名（38.5%）男性）进行，为期5年（从2001年至2006年）。研究对象为通过各种临床、细菌学和放射学特征以及结核菌素皮肤试验确诊为结核病的儿童。我们研究了这些儿童肺结核的放射学特征。观察到右肺受累占65%，左肺占23%，双侧受累占12%。此外，中叶和上叶是最常受累的叶。最常见的放射学特征是肺门（纵隔）淋巴结肿大；胸部X线（CXR）检查发现70%，CT扫描发现85%。右侧淋巴结受累更多；25%有钙化。此外，35%的CXR和61%的CT扫描观察到肺实质结节状浸润。其次分别在25%的CXR和35%的CT扫描中发现斑片状实变。我们还观察到，与年龄较大的儿童相比，3岁以下儿童的淋巴结受累最高，但实质病变最少。结论是原发性肺结核是儿童肺结核最常见的形式。这可能表现为伴有或不伴有肺实质受累的肺门淋巴结肿大。此外，放射学特征可为儿童肺结核的诊断、治疗和随访提供有价值的信息。
