儿童胸壁病变的影像表现与临床分析

目的 探讨儿童胸壁病变的临床及影像表现特点，提高对胸壁病变的诊断水平。方法 收集我院2009年10月-2018年6月经手术及病理证实的50例胸壁病变患儿，包括感染组（4例）和非感染组（46例），非感染组进一步分为良性肿瘤组（41例）和恶性肿瘤组（5例）。50例患儿均行超声、CT或MRI检查。对所有病例的临床及影像表现进行回顾性分析。结果 3组病例的临床及影像表现各有不同。①临床表现：感染组病人全部出现发热、胸痛、病灶局部红肿热的临床表现，且病变均质软；良性肿瘤组中质软出现率为90.2%（37/41）；恶性肿瘤组全部病变均质韧。3组病变移动性均差。感染组及恶性肿瘤组全部病例均有局部压痛，而良性肿瘤组压痛的发生率仅为7.3%（3/41）。②影像表现：良性肿瘤组中，75.6%（31/41）病变显示内部均匀，65.9%（27/41）边缘清晰；而感染组及恶性肿瘤组病灶内部不均匀，边缘模糊。良性肿瘤组中仅9.8%（4/41）病灶可见钙化，2.4%（1/41）病灶有出血，19.5%（8/41）病灶内部出现囊腔影，14.6%（6/41）病例可见肋骨破坏；恶性肿瘤组全部侵犯入胸腔并破坏肋骨；感染组均无肋骨破坏。感染组与恶性肿瘤组病变均呈明显强化，而良性肿瘤组中80.5%（33/41）表现为无/轻度强化。结论 不同性质胸壁病变临床特点各异，结合临床和影像特征可更好地诊断胸壁病变。

The imaging diagnosis and clinical analysis of chest wall lesions in children

Objection To explore the imaging and clinical features of chest wall lesions so as to improve diagnosis accuracy of the disease. Method Fifty patients with chest wall lesion by surgery and pathology were enrolled from October 2009 to June 2018 into this study. All fifth cases included 4 infectious lesions and 46 tumor/tumor-like lesions. All patients underwent US, chest CT and MRI. Clinical data and imaging findings of 50 cases of children with chest wall lesions were retrospectively analyzed, combined with relevant literatures. Results Three groups had obvious difference in clinical and imaging findings. Following fever, symptoms of Infectious lesions included redness, swelling, heat and pain. The odds ratio, 100%, was clearly higher than other two groups. All infectious lesions and 37 benign tumors were soft, and 5 malignant tumors were hard. Three groups of cases had poor mobility. The odds ratio of local tenderness in Infectious and malignant tumor group were higher than benign tumor group. In benign tumor group, the imaging findings showed 31 heterogeneous density cases and 27 untidy margin cases. The incidences were 62% (31/50) and 54% (27/50), but in infectious lesions and malignant tumors group, lesions appeared heterogeneous density and untidy margin. In benign group, there were 4 calcification, 1 hemorrhage and 8 cystic spaces, also the incidences were above other two groups. The odds ratio of rib destruction in benign is 12% (6/41), which was lower than malignant tumors group. All malignant tumors had rid destruction, while the lesions even pinpointed in the thoracic cavity. No rib damage was found in the infectious group. There were obvious enhancement in infectious and malignant tumor group, but most of benign tumors had non-enhancement to slight enhancement, whose incidence was 66%. Conclusion Various chest wall lesions had different and special clinical characteristics. We can make a correct diagnosis combining with the imaging features. If symptoms of chest wall lesions included fever, redness, swelling, heat and pain ,also the imaging findings showed heterogeneous density, untidy margin and obvious enhancement, we should consider them infectious lesions. If there were homogenous density, sharpness of border, and non-enhancement of lesions in chest wall lesions without fever, chest pain and rib destruction, we should probably consider them benign tumors. If lesions appeared heterogeneous density, untidy margin, obvious enhancement and even pinpointed in the thoracic cavity with chest pain, we will possibly regard them as malignant tumors.