tailieunhanh - Pediatric Chest Imaging - part 9

chẳng hạn như Candida [24]. X quang ngực hay CT ngực thường thể hiện hạch, viêm phổi tái phát, và làm dày màng phổi (Hình 5). [25]. Các biểu hiện chụp ảnh phóng xạ của Aspergillus khác nhau nhưng thâm nhập vào phân đoạn hoặc thùy phổi, opacities nốt, | THORACIC DISORDERS IMMUNOCOMPROMISED CHILD 439 occurs more commonly than other fungal infections such as Candida 24 . Chest radiographs or chest CT typically demonstrate lymphadenopathy recurrent pneumonia and pleural thickening Fig. 5 25 . The radiographic manifestations of Aspergillus vary but segmental or lobar infiltrates nodular opacities and cavitation are typical 24 . Although recurrent pneumonias and pulmonary abscesses are common other thoracic manifestations include lymphadenitis osteomyelitis and chest wall abscesses. Esophageal strictures can also be a complication of chronic granulomatous disease. Leukocyte adhesion deficiency results from a defect in the gene encoding CD18 a component of three different types of leukocyte adhesion molecules required for effective cell adhesion and migration 2 . This defect results in faulty phagocyte migration and ultimately increased host susceptibility to pyogenic infections. Severity of symptoms varies greatly but these patients typically present with recurrent bacterial pneumonias and other severe and repetitive bacterial infections. Other primary immunodeficiencies Hyperimmunoglobulinemia E syndrome typically is associated with widespread staphylococcal abscesses of the skin lungs viscera and other sites. Onset of symptoms characteristically occurs in infancy in association with markedly elevated serum IgE levels 26 . Pulmonary sequellae include recurrent staphylococcal pneumonias which typically result in pneumatocele formation Fig. 6 . The most striking radiographic manifestation of this disease is persistent single or multiple often large pneumatoceles. These pulmonary air cysts may persist expand or become superinfected. Not infrequently surgical Fig. 5. An 8-month-old boy with chronic granulomatous disease. A The initial frontal and lateral chest radiographs demonstrates pulmonary hyperinflation with diffuse nodular opacities and lymphadenopathy. Axial images from an intravenous contrast-enhanced chest scan