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伴有血管异常和心脏受累的结核性支气管压迫:一组病例展示诊断与管理

PTB airway compression complicated by vascular abnormalities and cardiac involvement: A case series demonstrating diagnosis and management.

作者信息

Goussard P, Eber E, Janson J, Gie A G, Fourie B, Jacobs C M, Venkatakrishna S S B, Andronikou S, Van der Westhuizen S, Schubert P, Burger C, Verster J, Ebert L, Deininger-Czermak E

机构信息

Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.

Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.

出版信息

Pediatr Pulmonol. 2025 Jan;60(1):e27351. doi: 10.1002/ppul.27351. Epub 2024 Oct 28.

DOI:10.1002/ppul.27351
PMID:39467103
Abstract

INTRODUCTION

Lymphobronchial tuberculosis (LBTB) is a tuberculous lymphadenopathy causing airway compression in young children. While it can occur in older children due to factors such as airway size, wall weakness, and immune reconstitutions, severe airway obstruction is more common in younger children.

METHODS

Chest X-rays show airway compression, while bronchoscopy is the gold standard for confirming TB-induced airway compression. Previous research has demonstrated that drug resistance and HIV have no effect on the outcome of children with significant airway compression caused by TB.

RESULTS

This case series describes the management and outcome of three young children who had simultaneous vascular abnormalities and airway obstruction due to pulmonary tuberculosis (PTB). Concomitant PTB and vascular abnormalities are uncommon, even in high-TB-intensity areas, and affected children may present differently and require individualised treatment.

CONCLUSIONS

Advanced imaging is critical for detecting complicated cases of airway compression due to PTB in young children, as vascular abnormalities are uncommon. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) may show metabolically active intracardiac lesions. Individualised management plans are required for these children, and echocardiography is critical for patients with disseminated disease.

摘要

引言

淋巴支气管结核(LBTB)是一种导致幼儿气道受压的结核性淋巴结病。虽然由于气道大小、管壁薄弱和免疫重建等因素,它也可能发生在大龄儿童中,但严重气道阻塞在幼儿中更为常见。

方法

胸部X线显示气道受压,而支气管镜检查是确诊结核引起气道受压的金标准。先前的研究表明,耐药性和艾滋病毒对结核导致严重气道受压儿童的预后没有影响。

结果

本病例系列描述了三名因肺结核(PTB)同时出现血管异常和气道阻塞的幼儿的治疗及预后情况。即使在结核病高发地区,PTB与血管异常同时存在也不常见,患病儿童的表现可能不同,需要个体化治疗。

结论

由于血管异常并不常见,先进的影像学检查对于检测幼儿因PTB导致的复杂气道受压病例至关重要。氟-18氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描(F-18 FDG PET/CT)可能显示心脏内代谢活跃的病变。这些儿童需要个体化的管理计划,超声心动图对播散性疾病患者至关重要。

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