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[儿童遗传性出血性毛细血管扩张症病例报告及文献复习]

[Case report of hereditary hemorrhagic telangiectasia in children and literature review].

作者信息

Liu J R, Liu H, Wang B, Zhang Y H, Xu H, Tang X L, Li H M, Zhao S Y

机构信息

Department No. 2 of Respiratory Diseases, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing 100045, China.

Center of Imaging, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing 100045, China.

出版信息

Zhonghua Er Ke Za Zhi. 2020 Aug 2;58(8):674-678. doi: 10.3760/cma.j.cn112140-20200415-00386.

Abstract

To analyze the clinical features of 2 children with hereditary hemorrhagic telangiectasia (HHT) and review relevant literature. The clinical data of 2 children with HHT who were admitted to Beijing Children's Hospital, Capital Medical University from February 2017 to June 2018 were retrospectively analyzed. Meanwhile, the relevant papers published before December 2019 in Wanfang and Pubmed database were searched with the key words of "hereditary hemorrhagic telangiectasia" in Chinese and English, and reviewed. The first case was an 11-year-old boy, presented with fever and cough for 6 days. His past history revealed 3 times of left pneumonia and mild epistaxis. Ultrasound of the chest soft tissue found hemangioma and vascular malformation. Enhanced CT with vascular reconstruction suggested pulmonary arteriovenous malformation and multiple arteriovenous fistulas in the liver. After being treated with interventional pulmonary arteriovenous fistula embolization, his condition improved. The second case was a 12-year-old girl, presented with iron deficiency anemia during the past 3 years. Endoscopic resection of polyps had been performed before due to multiple polyps in the colon. High-resolution lung CT revealed multiple ground-glass nodules in bilateral lungs. Ultrasound of the digestive tract suggested small intestine polyps and secondary chronic loose intussusception. After admission, small bowel intussusception reduction was performed, and the polyps were ligated. Her whole exon gene testing suggested SMAD4 heterozygous variation. In the large number of reported cases, HHT1 and HHT2 are the main type. Children with HHT may present with anemia and repeated intestinal polyps. It is worth noting that visceral arteriovenous malformations, such as pulmonary arteriovenous malformations, which is easily misdiagnosed as recurrent pneumonia, can also occur in children with HHT. Enhanced CT with vascular reconstruction can help find pulmonary arteriovenous malformation, and timely genetic test can confirm the diagnosis.

摘要

分析2例遗传性出血性毛细血管扩张症(HHT)患儿的临床特征并复习相关文献。回顾性分析2017年2月至2018年6月首都医科大学附属北京儿童医院收治的2例HHT患儿的临床资料。同时,以“遗传性出血性毛细血管扩张症”中英文为关键词,检索2019年12月以前万方和Pubmed数据库发表的相关论文并进行复习。第1例为11岁男孩,因发热、咳嗽6天就诊。既往史有3次左肺炎及轻度鼻出血。胸部软组织超声发现血管瘤及血管畸形。增强CT血管重建提示肺动静脉畸形及肝脏多发动静脉瘘。经介入性肺动静脉瘘栓塞治疗后病情好转。第2例为12岁女孩,近3年出现缺铁性贫血。既往因结肠多发息肉行内镜下息肉切除术。高分辨率肺CT显示双肺多发磨玻璃结节。消化道超声提示小肠息肉及继发性慢性肠套叠。入院后行小肠套叠复位及息肉结扎术。其全外显子基因检测提示SMAD4杂合变异。在大量报道病例中,HHT1和HHT2为主要类型。HHT患儿可能出现贫血及反复肠道息肉。值得注意的是,HHT患儿也可发生内脏动静脉畸形,如肺动静脉畸形,易误诊为反复肺炎。增强CT血管重建有助于发现肺动静脉畸形,及时进行基因检测可明确诊断。

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