Khảo sát đặc điểm của CT scan xương thái dương trong bệnh lý viêm xương chũm cấp ở trẻ em tại Bệnh viện Nhi Đồng 1=Evaluation of temporal bone CT scan features of acute mastoiditis in children at Children’s Hospital 1

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Tác giả: Minh Trí Nguyễn, Đình Nguyên Phạm

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.359-367

Bộ sưu tập: Báo, Tạp chí

ID: 243566

Thêm vào giỏ

Describe clinical features of acute mastoiditis in children
Imaging features of acute mastoiditis on CT scan of the temporal bone, and the correlation between images and clinical symptoms and treatment. Methods: A retrospective and prospective descriptive study was conducted on children <
16 years old diagnosed with acute mastoiditis having CT scan of the temporal bone at Children's Hospital 1 from January 1, 2020 to October 30, 2023. Results: We collected 54 children who met the sample selection criteria, including 28 cases of mastoiditis on both sides. Clinical symptoms: 61.1% had cough, runny nose, 37% fever, 35.2% earache, 85% red swelling behind the ear, 79.6% tympanic membrane congestion, 44.4% eardrum bulging, 27.8% ear canal edema, 11.1% otorrhea. CT scan features: opacification of middle ear 95.1%, mastoid antrum 98.9%, mastoid air cells 100%. Resorption of tegmen 1,2%, air cells septae 70.7%, outer cotex 47.6% and sigmoid plate 4.9%. Subperiosteal abscess 36.6%, sigmoid vein thrombosis 2.4%, epidural abscess 2.4% and intracranial fluid accumulation in front of the transverse sinus 2.4%. There was a significant difference in the indication for mastoidectomy between the group of children with signs of bone resorption and the group without signs of bone resorption. In which, signs of subperiosteal abscess have the strongest correlation with mastoid surgery (p <
0.001, OR = 17.68). Conclusion: Acute mastoiditis is common in children. Systemic symtomps are cough, rhinorrhea, otalgia. Local symtomps are postauricular swelling, otorrhea. Intratemporal and intracranial compications of acute mastoiditis are not rare. Temporal CT scan is a valuable tools to identify the lesions and to detect complication early. Bone resorption and subperiosteal abscess on CT scan are signs to consider mastoid surgery.Mô tả đặc điểm lâm sàng của viêm tai xương chũm cấp ở trẻ em
đặc điểm hình ảnh học của viêm tai xương chũm cấp trên phim CT scan xương thái dương và sự tương quan giữa hình ảnh học với triệu chứng lâm sàng và điều trị. Đối tượng và phương pháp: Nghiên cứu mô tả hồi cứu kết hợp tiến cứu được thực hiện trên trẻ <
16 tuổi được chẩn đoán viêm tai xương chũm cấp và chụp CTscan xương thái dương tại Bệnh viện Nhi Đồng 1 từ tháng 01/2020 đến 30/10/2023. Kết quả: Chúng tôi thu thập được 54 trẻ đáp ứng tiêu chuẩn chọn mẫu trong đó có 28 trường hợp bị viêm tai xương chũm cả 2 bên. Đặc điểm lâm sàng: 61,1% ho, sổ mũi, 37% sốt, 35,2% đau tai, 85% sưng đỏ sau tai, 79,6% sung huyết màng nhĩ, 44,4% phồng màng nhĩ, 27,8% phù nề ống tai, 11,1% chảy mủ tai. Đặc điểm CT scan: hòm nhĩ mờ 95,1%, sào bào mờ 98,9%, mờ các thông bào chũm 100%, hủy xương trần thượng nhĩ 1,2%, hủy xương vách thông bào 70,7%, hủy xương vỏ ngoài xương chũm gặp trong 47,6%, hủy xương vỏ xương trên xoang xích ma 4,9%. Áp xe dưới màng xương 36,6%, huyết khối xoang tĩnh mạch xích ma (2,4%), tụ dịch nội sọ trước xoang tĩnh mạch ngang (2,4%) và áp xe ngoài màng cứng (2,4%). Có sự khác biệt đáng kể về chỉ định phẫu thuật mở xương chũm giữa nhóm trẻ có dấu hiệu huỷ xương và nhóm không có dấu hiệu huỷ xương. Trong đó, dấu hiệu áp xe dưới màng xương có tương quan mạnh nhất với phẫu thuật xương chũm (p <
0,001, OR = 17,68). Kết luận: Viêm tai xương chũm cấp khá phổ biến ở trẻ em với biểu hiện toàn thân thường gặp như sốt, ho, sổ mũi, đau tai. Đa số bệnh nhi có tình trạng sưng đau sau tai, phù nề ống tai, chảy mủ tai. Một tỉ lệ không nhỏ các trẻ có biến chứng xương thái dương hoặc biến chứng nội sọ. Chỉ định CT scan xương thái dương có hiệu quả trong việc xác định thương tổn và phát hiện sớm biến chứng ngay cả khi chưa có biểu hiện lâm sàng. Hình ảnh huỷ xương, áp xe dưới màng cứng là những dấu hiệu để cân nhắc chỉ định phẫu thuật mở xương chũm.

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