Pediatric Unilateral Lung Abnormal Luminosity Syndrome
Introduction
Brief introduction of unilateral lung abnormal translucent syndrome in children Children with unilateral lung abnormal translucent or excessive translucent syndrome is Macleodssyndrome, also known as Swyer-James syndrome, Swyer-James-Macleod syndrome. An X-ray sign, rather than a disease name, such as unilateral lung abnormality, pulmonary dysplasia, unilateral non-functional lung, idiopathic unilateral translucent lung, unilateral transparent lung, etc., although their names are different, The same X-ray performance, that is, the translucent brightness of the diseased side lung is significantly higher than that of the healthy side lung. basic knowledge The proportion of illness: 0.002% Susceptible people: children Mode of infection: non-infectious Complications: pneumonia
Cause
Causes of unilateral lung abnormal translucent syndrome in children
Pulmonary infection (30%):
Pulmonary infection in childhood may be a potential cause of this disease, especially viral (including adenovirus, syncytial virus) pneumonia has a special significance, Reid reported 2 children, all with unilateral lung hyperplasia after measles Translucent, chest X-ray examination before measles, no abnormalities, it proves that this syndrome is the result of postnatal infection, some people believe that lung infection is not the main direct cause of this disease.
Congenital dysplasia (15%):
Unilateral pulmonary dysplasia caused by congenital dysplasia is also common in pulmonary artery abnormalities, most of which are pulmonary dysplasia, and very few are pulmonary artery dysplasia. According to the hemodynamic examination of patients with unilateral pulmonary hyperpermeability, the pulmonary vasculature of the affected side is found. There is a different degree of resistance increase, so that most of the blood flow to the healthy side of the lung, the pulmonary circulation of the affected side is reduced, resulting in pulmonary dysplasia, Raymond et al reported 5 cases of acquired unilateral pulmonary dysplasia, stressed Pneumonia in childhood is an important factor in causing pulmonary dysplasia.
The bronchi is blocked by foreign objects (20%):
This symptom can also be caused by obstruction of unilateral bronchus (including bronchial secretions and foreign bodies), resulting in X-ray changes in unilateral lung abnormalities. Margolin performed bronchoscopy on 4 cases of unilateral lung hyperpermeability, 2 of which There was a history of foreign body inhalation, but no foreign bodies were found.
Unilateral bronchial compression by foreign bodies (20%):
Causes poor breathing or obstruction of the respiratory tract, which can cause differences in the transparency of the lungs on both sides, such as chest tumors or cysts.
Prevention
Prevention of unilateral lung abnormal translucent syndrome in children
Actively prevent respiratory infections and prevent the occurrence of foreign bodies in the respiratory tract.
Complication
Complications of unilateral lung abnormal translucent syndrome in children Complications pneumonia
There may be a history of repeated infections of the lungs or bronchi.
Symptom
Symptoms of unilateral lung abnormal translucent syndrome in children Common symptoms Repeated infection, phlegm, blood stasis, dryness, dryness, dyspnea
The symptoms are more common in children. The incidence of males is higher than that of females. The clinical manifestations are extremely atypical. They can be unconscious. They can only be found during physical examination. They can also have a history of repeated infections of the lungs or bronchus, coughing, phlegm and occasional hemoptysis. The percussion of the affected side is drum sound. When the auscultation is performed, the breath sound is reduced or disappeared. Sometimes the wet sound is heard or scattered. If the affected side is left lung, the heart sounds will shrink or disappear. The affected side is the right lung. Then the liver dullness is reduced.
If inhaled by foreign body, there is a typical medical history, severe cough, followed by vomiting and difficulty in breathing. After a while, the symptoms are gradually relieved or relieved. Later, depending on where the foreign body stays, different symptoms appear. When unilateral lung abnormality occurs, foreign matter occurs. Mostly located in the unilateral bronchus.
Examine
Examination of unilateral lung abnormal translucent syndrome in children
In the case of concurrent infection, peripheral blood may have a significant increase in white blood cell count and neutrophils, and no other findings were found in other tests.
1. X-ray examination: The main means for diagnosing this syndrome, chest X-ray film shows that the affected side of the whole lung is excessively translucent or the hilar shadow is reduced, the pulmonary vascular texture is slender, sparse and/or straight, and the fluoroscopy is deep breathing. When the mediastinum and the heart are gently pushed to the healthy side, the mediastinum swings to the affected side during deep inhalation, or the range of the diaphragmatic muscle of the diseased side is restricted. The top of the diaphragm is flat and the position is low. The stratified radiograph shows that the affected side has few pulmonary vessels. This is caused by alveolar inflation.
2. Bronchography: It can be seen that its performance changes with different diseases. Due to excessive fluoroscopy of unilateral lung caused by pulmonary vascular abnormalities, bronchial lesions can be widely distributed, with varying degrees and types of bronchiectasis, and bronchial tree periphery (5 6 grades and 6-7 grades or less) The branches are not filled or deformed.
3. Angiography: In some cases, the diameter of the affected pulmonary artery is narrow, and the surrounding is poorly filled or completely unfilled.
Diagnosis
Diagnosis and diagnosis of unilateral lung abnormal translucent syndrome in children
diagnosis
The diagnosis of this disease mainly relies on X-ray examination, followed by bronchography, and angiography is also helpful.
Differential diagnosis
In the process of diagnosing this symptom, attention should be paid to the identification of the following diseases.
Chest wall deformity
Including the posterior scoliosis, lack of breasts, unilateral pectoralis major muscle loss.
2. Contralateral lung transparency is reduced
(1) pleural thickening: When the lungs are infected in childhood, the pleura is often invaded; generally no exudate or exudate is very small, and the cellulose layer is left after rapid absorption, and adhesion is formed until later. When pleural surgery or post-mortem autopsy, the pleural adhesions were found to be thickened, the chest was fluoroscopy, and the healthy side was relatively translucent.
(2) Exudative pleurisy: When there is a small amount of effusion in the unilateral pleural cavity, the signs are not obvious. If the patient is lying flat, the transparency of the affected side is reduced, and the transparency of the contralateral lung is increased.
3. Emphysema
Clinically, emphysema is often divided into four types: compensatory emphysema, obstructive emphysema, interstitial emphysema, and bullous bullae. The first two types of emphysema can cause excessive unilateral lung translucent.
(1) Compensatory emphysema: more common in pneumonitis with atelectasis, due to local (large leaf) dysfunction, in order to compensate for the lack of ventilation, causing excessive expansion of other lungs, once the disease is cured, emphysema It disappeared.
(2) Obstructive emphysema: due to foreign body inhalation or main, viscous secretions in the bronchial cavity are blocked, that is, partial obstruction occurs, due to strong contraction of the diaphragm and respiratory assist muscle during inhalation, resulting in alveolar pressure and external pressure The gap increases; at the same time, the bronchial cavity is temporarily dilated due to reflex, so the air easily flows through the obstruction site and enters the alveoli. When exhaled, the bronchi is contracted, and the air accumulated in the alveoli gradually increases, and finally the elasticity of the alveolar wall It gradually disappears and can be severed to form a localized emphysema.
In emphysema, the thoracic bulge, the lung occupying area is enlarged, the intercostal space is widened, the diaphragmatic movement is restricted or the lower part is flattened, and the peripheral branch of the affected pulmonary artery is sparse and small, but the main branch of the pulmonary artery or the branch of the hilar is obviously enlarged. For its X-ray characteristics, in addition, the transparency of the lungs is increased, especially when exhaling, the transparency is not reduced, or even in the state of inhalation when exhaled, which is the performance of obstruction and residual gas.
4. Unilateral pneumothorax
Sudden onset, severe anger, nasal agitation, superficial breathing, chest pain, frequent cough, bruising and other symptoms, but some cases have slow onset without obvious symptoms, and must be differentiated from unilateral lung hyper-transparent.
