Donnelly L F, Klosterman L A
Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.
AJR Am J Roentgenol. 1998 Jun;170(6):1627-31. doi: 10.2214/ajr.170.6.9609186.
Our purpose was to investigate the usefulness of CT in evaluating children who do not respond appropriately to treatment for pneumonia, when chest radiography is noncontributory.
Fifty-six contrast-enhanced CT scans were compared with radiographs obtained on the same day in children with complicated pneumonia. CT scans were evaluated for clinically significant findings that were not revealed by radiography: lung parenchymal complications (cavitary necrosis, abscess, decreased enhancement, bronchopleural fistula, or cavity suspected on radiography but not seen on CT), pleural complications (loculation, malpositioned chest tube), inaccurate estimation of cause of chest opacity on radiography (pleural versus parenchymal), bronchial obstruction, or pericardial effusion.
One hundred ten CT findings, not revealed by radiography, were seen on 56 CT scans (2.0 per CT scan): parenchymal complications (n = 40), pleural complications (n = 37), inaccurate estimation of cause of chest opacity on radiography (n = 20), pericardial effusion (n = 13). All CT scans showed at least one significant finding (100% yield) not seen on radiography.
In the evaluation of children with complicated pneumonia, CT often reveals clinically significant findings not apparent on radiography.
我们的目的是研究在胸部X线检查无诊断价值时，CT对评估肺炎治疗反应不佳儿童的有用性。
对56例复杂性肺炎儿童的增强CT扫描结果与同日获得的X线片进行比较。评估CT扫描是否存在X线片未显示的具有临床意义的表现：肺实质并发症（空洞性坏死、脓肿、强化降低、支气管胸膜瘘或X线片怀疑但CT未显示的空洞）、胸膜并发症（包裹性积液、胸腔引流管位置不当）、X线片对胸腔积液病因的估计不准确（胸膜性与实质性）、支气管阻塞或心包积液。
在56例CT扫描中发现了110个X线片未显示的CT表现（平均每例CT扫描2.0个）：实质并发症（n = 40）、胸膜并发症（n = 37）、X线片对胸腔积液病因的估计不准确（n = 20）、心包积液（n = 13）。所有CT扫描均显示至少一项X线片未发现的具有显著意义的表现（阳性率100%）。
在评估复杂性肺炎儿童时，CT常能发现X线片未显示的具有临床意义的表现。
