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Objective To investigate and summarize the clinical and high-resolution computed tomography(HRCT) characteristics of invasive pulmonary fungal infections(IPFIs)in children.Methods Clinical and HRCT data of 35 cases with IPFIs admitted in our hospital between March 2007 and July 2015 were retrospectively analyzed.The clinical and HRCT characteristics were summarized.Results Thirty-five patients consisted of 23 boys and 12 girls with mean age of(3.2±1.9) years.Host factors included acute leukemia (n=12),primary immunodeficiency disease (n=4),congenital heart disease (n=2),cerebral palsy (n=2),severe influenza A infection (H1N1) (n=2),ichthyosis (n=1),acquired immunodeficiency syndrome(n=1),systemic lupus erythematous (n=1),tubercular meningitis(n=1),mechanical ventilation(n=2).All patients were treated with broad-spectrum antibiotic,ranking by descending order:third-generation cephalosporins (28 cases),carbapenems(19 cases)and vancomycin (18 cases).Seventeen cases were treated with corticosteroids systemically and 12 cases with acute leukemia took antineoplastic medicine.The symptoms of IPFIs were intermittent or persistent fever,cough and rales.HRCT results:nodules (n=25,71.4％),subpleural patchy opacities (n=24,68.6％),mass (＞3cm) (n=4,11.4％),halo sign (n=27,77.1％),cavities (n=8,22.9％),air crescent sign (n=4,11.4％),miliary nodules (n=2,5.7％),pleural effusion (n=14,40％).Conclusion There are certain specific characteristics of IPFIs in children in clinical and HRCT aspects.The possible diagnosis of IPFIs can be made based on clinical and HRCT features.
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Objective To explore the MRI features of Langerhans cell histiocytosis (LCH) in central nervous system (CNS) in children. Methods Clinical and MRI data of 25 cases with LCH in CNS from three children's hospitals between January 2009 and December 2014 were retrospectively studied. All cases were confirmed by surgery or biopsy. All cases underwent non?contrast and contrast pituitary and/or cranial MRI examinations. The location, morphology, MRI signal and enhanced patterns of LCH lesions were observed and analyzed. Result A total of 17 cases had hypothalamic-pituitary LCH, with 2 of them complicated with pineal cyst, 2 complicated with brain parenchymal lesions, and one complicated with both pineal cyst and brain parenchymal lesions. MR images showed that neurohypophysis lost its original hyper?intensity on T1WI, and nodular or homogeneous thickening was seen in the pituitary stalks. Dura matter was involved in 3 cases, 2 of them had single lesion, and the other one got multiple lesions. Neoplasm in choroid plexus was seen in trigone of left lateral ventricles in one case. Three cases with pineal gland involved demonstrated cystic change. Four cases had gray matter involved, with cerebellar dentate nuclei involvement in 2 cases, and both thalamus and basal ganglia involvement in the other two cases. Three cases showed white matter involvement without obvious Virchow-Robin space enlargement and brain atrophy. Conclusions MR imaging of LCH in CNS shows certain specific characteristics. The diagnosis can be made comprehensively based on both clinic features and other imaging findings.
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<p><b>OBJECTIVE</b>To analyze the clinical characteristics of negative pressure pulmonary edema (NPPE).</p><p><b>METHOD</b>A retrospective investigation of the clinical manifestation, imageology, clinical course and outcome of 4 children with NPPE seen between June 2012 and July 2013 in a children's hospital. The causation of the airway obstruction was also explored.</p><p><b>RESULT</b>All the 4 cases were boys, the range of age was 40 days to 9 years. They had no history of respiratory and circulatory system disease. In 3 cases the disease had a sudden onset after the obstruction of airway, and in one the onset occurred 1.5 hours after removing the airway foreign body. All these cases presented with tachypnea, dyspnea, and cyanosis, none had fever. Three cases had coarse rales. Chest radiography was performed in 3 cases and CT scan was performed in 1 case, in all of them both lungs displayed diffuse ground-glass-like change and patchy consolidative infiltrates. Three cases were admitted to the ICU, duration of mechanical ventilation was less than 24 hours in 2 cases and 39 hours in one. Oxygen was given by mask to the remaining one in emergency department, whose symptoms were obviously improved in 10 hours. None was treated with diuretics, glucocorticoids or inotropic agents. Chest radiographs were taken within 24 hours of treatment in 2 cases and 24-48 hours in the other 2; almost all the pulmonary infiltrates were resolved. All the 4 cases were cured. The causes of airway obstruction were airway foreign bodies in two cases, laryngospasm in one and laryngomalacia in the other.</p><p><b>CONCLUSION</b>NPPE is a life-threatening emergency, which is manifested by rapid onset of respiratory distress rapidly (usually in several minutes, but might be hours later) after relief of the airway obstruction, with findings of pulmonary edema in chest radiograph. The symptoms resolve rapidly by oxygen therapy timely with or without mechanical ventilation. In children with airway obstruction, NPPE should be considered.</p>