儿童新型冠状病毒感染并发纵隔气肿8例影像学及临床特点分析

Background The imaging of COVID-19COVID-19 in children is different from that of adultsmainly manifested as subpleural ground glass shadowspatchy high-density shadowand solid shadowand rarely complicated with pneumomediastinum. The formation of a large number of emphysema can seriously affect the respiratory and circulatory functionresulting in obvious wheezing and hypoxemiawhich need to be actively treated. Objective To analyze and summarize the imaging and clinical characteristics of COVID-19 with pneumomediastinum in children. Methods A retrospective analysis was conducted on 8 pediatric patients with COVID-19 complicated with pneumomediastinum admitted to the Department of Pediatrics at Jingzhou Hospital affiliated with Yangtze University from December 12022 to January 302023including agegenderimagingclinical characteristicsand treatment. Results 8 children were 3.5 years to 12 yearswith a female ratio of 3 5. High Resolution CT Scan in all children showed double lung infection combined with pneumomediastinum and multiple emphysema involved the neck and chest wall. The pulmonary manifestations were varioussubpleural ground glass shadowconsolidationtree bud signvascular bronchial bundle thickening and bronchial wall thickeninggrid signetc.no large consolidation and "white lung" found. One case was observed to have a small amount of pleural effusion. In addition to fever and coughthe clinical manifestations were obvious shortness of breathpulmonary auscultationbut dry or moist rales were not significant. Four children with mycoplasma infection were treated with azithromycinand one with B. catarrhalis. was treated with azithromycin. All given oxygen therapy. A patient was treated with an invasive ventilator because traditional treatment was unable to alleviate her dyspnea and hypoxemia. The patient's leucocytes and hypersensitive CRP were significantly increased. After 3 daysthe symptoms improved and the machine was successfully withdrawn. 5 cases were treated with intravenous immunoglobulin IVIGand 3 cases were treated with glucocorticoids. a week after the review of chest CTpneumomethinum were completely absorbedand lung lesions significantly improved. Conclusion Children with pneumomediastinum complicated by COVID-19 were mostly pre-school or school-age childrenrare in infants. Pneumomediastinum can coexist with gas accumulation in the neck and chest wall. In additionpulmonary lesions could involve the stroma or parenchymaand both lungs were affected with various manifestations. At the onset of the diseasethere were obvious shortness of breathactive oxygen therapy was recommended. When the white blood cell count and hypersensitivity CRP significantly increaseclose attention should be paid to respiratory conditions. IVIG and glucocorticoids may have positive effectsand if necessarya mechanical ventilation should also be used.