摘要
目的探讨肺结节病的误诊原因及防范误诊措施。方法回顾性分析2021年1—12月收治的曾误诊的肺结节病9例的临床资料。结果2例因浅表淋巴结无痛性增大、低热、食欲减退、恶心、盗汗、体质量减轻、皮肤瘙痒、气急,血白细胞计数、中性粒细胞计数升高及胸部影像学检查提示肺门及纵隔淋巴结增大,初步诊断为纵隔淋巴瘤;3例因乏力、盗汗、食欲减退、低热,伴咳嗽、痰中带血1例,胸闷、气急1例,血红细胞沉降率升高,结核菌素纯蛋白衍生物(PPD)试验弱阳性及胸部影像学检查提示双肺纤维条索样高密度影,初步诊断为原发性肺结核;4例因刺激性干咳、声音嘶哑、气短、低热、胸痛、咯血等症状就诊,胸部影像学检查均提示肺门及纵隔淋巴结增大,初步诊断为中心型肺癌。2例行浅表淋巴结活检术,7例行经CT引导下肺穿刺活检术,确诊为肺结节病。误诊时间为2~5个月。9例确诊后均予醋酸泼尼松治疗,总疗程为1年,肺部病灶明显吸收,临床症状明显改善,随访6个月未见复发。结论肺结节病早期无特异性表现,影像学表现多以双肺门及纵隔淋巴结对称性增大为主,易误诊为肺癌、纵隔淋巴瘤、肺结核等多种肺部疾病。熟知本病临床及影像学表现,提高警惕性,仔细鉴别诊断,尽早行经CT引导下肺穿刺活检术、纤维支气管镜黏膜活检及浅表增大淋巴结活检,有利于提高本病的确诊率。
Objective To explore the causes of misdiagnosis of pulmonary sarcoidosis and the measures to prevent misdiagnosis.Methods The clinical data of 9 patients with misdiagnosed pulmonary sarcoidosis admitted from January to December 2021 were retrospectively analyzed.Results Two patients were initially diagnosed as mediastinal lymphoma due to painless enlargement of superficial lymph nodes,low fever,loss of appetite,nausea,night sweats,loss of body mass,skin pruritus,shortness of breath,elevated white blood cell count and neutrophil count,and chest imaging examination indicating enlargement of hilar and mediastinal lymph nodes.Due to fatigue,night sweats,loss of appetite,low fever,cough,blood in sputum in 1 case,chest tightness and shortness of breath in 1 case,increased red blood cell sedimentation rate,weak-positive reaction of purified protein derivative(PPD)test,and chest imaging examination that showed the double lung fiber cord like high-density shadow,preliminary diagnosis was primary pulmonary tuberculosis.Four patients presented with irritant dry cough,hoarseness,shortness of breath,low fever,chest pain,and hemoptysis.Chest imaging examination indicated enlargement of hilar and mediastinal lymph nodes,and the preliminary diagnosis was central lung cancer.Superficial lymph node biopsy was performed in 2 patients,and CT-guided puncture biopsy was performed in 7 patients.The duration of misdiagnosis was 2-5 months.All the 9 patients were treated with Prednisone Acetate after diagnosis,for a total course of treatment for 1 year.The lung lesions were obviously absorbed,the clinical symptoms were obviously improved,and no recurrence was found at 6 months after follow-up.Conclusion Pulmonary sarcoidosis has no specific manifestations in its early stage,and its imaging manifestations are mainly symmetrical enlargement of both pulmonary hilar and mediastinal lymph nodes,which is more likely to be misdiagnosed as lung cancer,mediastinal lymphoma,tuberculosis and other lung diseases.Understanding the clinical and imaging manifestations of the disease,raising vigilance,carefully differentiating diagnosis,and performing CT-guided lung puncture biopsy,fibrobronchoscopic mucosal biopsy and superficial enlarged lymph node biopsy as soon as possible are beneficial to improving the diagnosis rate of the disease.
作者
谢云
任茂
XIE Yun;REN Mao(Department of Respiratory and Critical Care Medicine,the 980th Hospital of Joint Logistic Support Force of PLA,Shijiazhuang 050082,China)
出处
《临床误诊误治》
CAS
2023年第12期10-13,共4页
Clinical Misdiagnosis & Mistherapy
关键词
肺结节病
误诊
肺癌
纵隔淋巴瘤
肺结核
肺活检
淋巴结
鉴别诊断
Pulmonary sarcoidosis
Misdiagnosis
Lung cancer
Mediastinal lymphoma
Tuberculosis
Lung biopsy
Lymph nodes
Differential diagnosis
作者简介
谢云,本科,副主任医师。主要从事肺癌介入治疗、呼吸支持技术及重症肺部感染相关方向研究。
