Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Pediatr Pulmonol. 2022 Oct;57(10):2344-2355. doi: 10.1002/ppul.26038. Epub 2022 Jun 25.
Hypersensitivity pneumonitis (HP) is rare in the pediatric population. To date, there are no studies defining a correlation between clinical, radiological, and pathological findings in children with HP. The objective of this study is to define the clinical, and radiological characteristics and prognosis of childhood HP and to examine the clinical, radiological, and pathological correlation between HP stages.
Patients with suspected HP and followed at two tertiary care hospitals between 2000 and 2020 were retrospectively evaluated. Computed tomography (CT) of the chest of patients was evaluated by a single radiologist. The interagreement between clinical and radiological severity of the patients was calculated with the κ test.
Fourteen children with suspected HP were identified. The results of 10 patients with the definitive diagnosis were as follows: one patient (10%) had acute, five patients (50%) had subacute, and four patients (40%) had chronic HP. The most prominent findings in chest CT were hilar, or hilar and subcarinal lymphadenopathy (80%), centrilobular nodules (60%), patchy or diffuse ground-glass opacities (50%), and cysts (50%). The interagreement between clinical and radiological severity of the patients was 100% (approximate significance: 0.003). The diagnosis of four patients with suspected HP who were unresponsive to standardized medical treatments or developed multisystem involvement was diagnosed with other diseases. One patient (10%) with definitive chronic HP died due to respiratory failure during follow up.
Similar to adult HP, the prognosis is worse in children with existing fibrotic equivalents in chest CT. Patients who are not responding to standard medical treatments or develop multisystem involvement should be evaluated for other lung diseases.
儿童中发生过敏性肺炎（HP）较为罕见。迄今为止，尚无研究明确儿童 HP 患者的临床、影像学和病理学表现之间的相关性。本研究旨在明确儿童 HP 的临床和影像学特征及预后，并探讨 HP 各期之间的临床、影像学和病理学相关性。
回顾性分析 2000 年至 2020 年在两家三级保健医院就诊的疑似 HP 患儿。由一名放射科医生评估患者的胸部 CT 表现。采用 κ 检验计算患者临床和影像学严重程度的一致性。
共发现 14 例疑似 HP 的患儿，10 例确诊患儿的结果如下：1 例（10%）为急性、5 例（50%）为亚急性、4 例（40%）为慢性 HP。胸部 CT 最常见的表现为肺门或肺门及隆突下淋巴结肿大（80%）、小叶中心结节（60%）、斑片状或弥漫性磨玻璃影（50%）和囊肿（50%）。患者的临床和影像学严重程度之间的一致性为 100%（近似显著性：0.003）。4 例疑似 HP 且对标准治疗无反应或出现多系统受累的患儿被诊断为其他疾病。1 例（10%）慢性 HP 患儿在随访过程中因呼吸衰竭死亡。
与成人 HP 相似，胸部 CT 存在纤维化表现的儿童预后更差。对标准治疗无反应或出现多系统受累的患者应评估是否存在其他肺部疾病。
