Singh S, Greenberg S B
Pediatric Radiology, University of Alabama, School of Medicine, Birmingham, Alabama 35294, USA.
Pediatric Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
Clin Radiol. 2017 Nov;72(11):991.e15-991.e18. doi: 10.1016/j.crad.2017.06.123. Epub 2017 Jul 31.
To describe a new finding in patients with pectus excavatum - left lower lobe anterior basal segment hyperinflation [LABSH]. A secondary objective is to determine the frequency of the new finding and association with pectus excavatum severity.
The study population included 52 children who underwent preoperative computed tomography (CT) for the evaluation of pectus excavatum. A control group of 50 children was obtained after evaluating 137 CT examinations performed for other reasons. Patient age in both groups ranged from 12 to 20 years. The Haller index was calculated for all patients. LABSH was evaluated by visual inspection of lung windows. The difference in mean radiodensity measurements in regions of interest in the left and right anterior basal segments [ΔHU] was calculated. Spirometry was performed in 44 of the patients and the results were compared to Haller index severity and the presence of LABSH. Echocardiography reports were available for 50 children in the pectus excavatum group.
LABSH was identified by visual inspection in 15 patients [29%] and was significantly associated with a Haller index >4.0 (p=0.001). ΔHU for the patients with LABSH was 90.2 HU (standard deviation [SD]=37.7) and for the non-hyperinflated group -5.51 (SD=44.63), which was significant (p<0.0001). There was a significant association of LABSH with the pectus excavatum group as compared to the control group. The difference in mean Haller index for children with normal spirometry (4.4, SD=2.7) was not significantly different (p=0.9899) than for children with obstructive disease (4.5, SD=1). There was mild cardiac compression on two echocardiograms.
LABSH is a new sign associated with pectus excavatum. The sign suggests segmental bronchial compression caused by chest deformity results in segmental air trapping.
描述漏斗胸患者的一项新发现——左下叶前基底段肺过度充气[LABSH]。次要目的是确定这一新发现的发生率及其与漏斗胸严重程度的关联。
研究人群包括52名因评估漏斗胸而接受术前计算机断层扫描（CT）的儿童。在对137例因其他原因进行的CT检查进行评估后，选取了50名儿童作为对照组。两组患者年龄均在12至20岁之间。计算所有患者的哈勒指数。通过观察肺窗对LABSH进行评估。计算左右前基底段感兴趣区域平均放射密度测量值的差异[ΔHU]。对44例患者进行了肺功能检查，并将结果与哈勒指数严重程度及LABSH的存在情况进行比较。漏斗胸组的50名儿童有超声心动图报告。
通过观察发现15例患者[29%]存在LABSH，且与哈勒指数>4.0显著相关（p = 0.001）。LABSH患者的ΔHU为90.2 HU（标准差[SD]=37.7），非肺过度充气组为-5.51（SD = 44.63），差异有统计学意义（p < 0.0001）。与对照组相比，LABSH与漏斗胸组显著相关。肺功能正常儿童的平均哈勒指数（4.4，SD = 2.7）与阻塞性疾病儿童（4.5，SD = 1）相比，差异无统计学意义（p = 0.9899）。两份超声心动图显示有轻度心脏受压。
LABSH是与漏斗胸相关的一个新体征。该体征提示胸部畸形导致节段性支气管受压，进而引起节段性气体潴留。
