Abstract: Background The imaging of COVID-19（COVID-19） in children is different from that of adults，mainly manifested as subpleural ground glass shadows，patchy high-density shadow，and solid shadow，and rarely complicated with pneumomediastinum. The formation of a large number of emphysema can seriously affect the respiratory and circulatory function，resulting in obvious wheezing and hypoxemia，which 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 1，2022 to January 30，2023，including age，gender，imaging，clinical characteristics，and treatment. Results 8 children were 3.5 years to 12 years，with 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 various：subpleural ground glass shadow，consolidation，tree bud sign，vascular bronchial bundle thickening and bronchial wall thickening，grid sign，etc.，no large consolidation and "white lung" found. One case was observed to have a small amount of pleural effusion. In addition to fever and cough，the clinical manifestations were obvious shortness of breath，pulmonary auscultation，but dry or moist rales were not significant. Four children with mycoplasma infection were treated with azithromycin，and 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 After 3 days，the symptoms improved and the machine was successfully withdrawn. 5 cases were treated with intravenous immunoglobulin （IVIG），and 3 cases were treated with glucocorticoids. a week after the review of chest CT，pneumomethinum were completely absorbed，and lung lesions significantly improved. Conclusion Children with pneumomediastinum complicated by COVID-19 were mostly pre-school or school-age children，rare in infants. Pneumomediastinum can coexist with gas accumulation in the neck and chest wall. In addition，pulmonary lesions could involve the stroma or parenchyma，and both lungs were affected， with various manifestations. At the onset of the disease，there were obvious shortness of breath，active oxygen therapy was recommended. When the white blood cell count and hypersensitivity CRP significantly increase，close attention should be paid to respiratory conditions. IVIG and glucocorticoids may have positive effects，and if necessary，a mechanical ventilation should also be used.

Key words: COVID-19；Mediastinal emphysema；Clinical characteristics；Tomography, spiral computed；Child

摘要： 背景 儿童新型冠状病毒感染（COVID-19）影像学与成人有一定差异，主要表现为胸膜下磨玻璃影、斑片状高密度影、实变影等，合并纵隔气肿者并不多见。大量气肿形成可严重影响呼吸及循环功能，导致明显喘憋、低氧血症，需积极处理。目的 分析并总结儿童 COVID-19 并发纵隔气肿的影像学及临床特征。方法 回顾分析2022-12-01—2023-01-30 在长江大学附属荆州医院儿科住院的 8 例 COVID-19 并发纵隔气肿的患儿年龄、性别、影像学、临床特点及诊疗情况。结果 8 例患儿年龄 3 岁 7 个月 ~12 岁，男女比 3 ∶ 5，高分辨率 CT（HRCT）均显示双肺感染合并纵隔气肿。气肿多同时累及颈部及胸壁。肺部表现多种多样：胸膜下磨玻璃影、实变、树芽征、支气管血管束增粗、支气管壁增厚及网格征等，未见大片实变及“白肺”。1 例患儿合并少量胸腔积液。临床表现除有发热、咳嗽外，均有明显气促，肺部听诊干湿啰音可不显著。4 例合并肺炎支原体感染、1 例合并卡他布兰汉菌感染。合并肺炎支原体感染者应用阿奇霉素，合并卡他布兰汉菌感染者给予头孢噻肟治疗。8 例患儿均给予氧疗。1 例患儿白细胞总数及超敏 -C 反应蛋白明显升高，明显气急，低氧血症，常规治疗无好转，给予有创呼吸机治疗 3 d 后好转撤机。5 例应用静脉丙种球蛋白（IVIG），3 例使用糖皮质激素。1 周后复查胸部 CT，纵隔气肿均完全吸收，肺部病灶明显好转。结论 COVID-19 并发纵隔气肿者多为学龄前期或学龄期儿童，婴幼儿少见。可同时合并颈部及胸壁积气。肺部病变可累及间质或实质、双肺均受累，表现形式多样。起病多有明显气急，积极氧疗。白细胞计数明显升高，同时超敏 -C反应蛋白明显升高者，要严密关注呼吸情况，积极使用 IVIG，适时适量应用糖皮质激素，必要时采用呼吸机人工辅助通气。

关键词: 新型冠状病毒感染；纵隔气肿；临床特征；体层摄影术, 螺旋计算机；儿童