老年人不典型肺结核与肺癌相互误诊的影像分析  

Image analysis on misdiagnosis between atypical pulmonary tuberculosis and lung cancer in aged

作　　者：左开荣 蒋明 何桂明 李琳 

机构地区：[1]江津区第二人民医院放射科,重庆江津402289 [2]南川区人民医院放射科,重庆南川408400

出　　处：《现代医药卫生》2009年第12期1765-1767,共3页Journal of Modern Medicine & Health

摘　　要：目的:探讨不典型肺结核与肺癌的影像特征及相互误诊原因。方法:对50例经临床病理证实的老年人不典型肺结核和肺癌进行回顾性分析。结果:50例中,误诊为肺癌的不典型肺结核22例,误诊为肺结核的不典型肺癌28例。22例不典型肺结核中,肿块或结节型13例,肺炎实变型6例,肺不张型3例;28例不典型肺癌中,结节或肿块型16例,肺炎实变型8例,磨玻璃密度影2例,粟粒样病变2例。病理结果:腺癌12例,鳞癌9例,腺鳞癌3例,肺泡癌3例,类癌1例。误诊时间:1个月以内20例,1～3个月12例,3个月以上18例。结论:老年人不典型肺结核与肺癌其临床症状多不典型,影像学上存在交叉重叠现象,应密切结合纤支镜检、肺穿刺活检、CT增强检查、痰脱落细胞检查、查痰(痰涂片或痰培养)以及诊断性抗痨治疗等措施并结合临床表现综合分析,对大多数病例能够作出正确诊断,减少误诊。Objective：To investigate the image features and misdiagnosis causes between atypical pulmonary tuberculosis and lung cancer in order to improve the ability of differential diagnosis. Methods：The data of 50 cases with atypical pulmonary tuberculosis and lung cancer confirmed by clinic, operation and pathology were analyzed retrospectively. Results：Of the 50 cases, 22 were atypical pulmonary tuberculosis misdiagnosed as lung cancer, and 28 were atypical lung cancer misdiagnosed as pulmonary tuberculosis. In the 22 cases of atypical pulmonary tuberculosis,there were mass or nodule （n=13）, pneumonia-like consolidation （n=6）and pulmonary atelectasis （n=3）; among the 28 cases of atypical lung cancer,there were nodule or mass （n=16）,pneumonia-like consolidation （n=8）,military lesions （n=2） and ground-glass opacity（n=2）. Pathological results were adeno-carcinoma（n=13）,squamons carcinoma（n=9）,adenosquamons careinoma（n=3） ,alveolar carcinoma（n=3） and careinoid tumors（n=l）.Misdiagnosis period： ≤ 1 months（n=20）, 1-3 months（n=12）,≥3 months（n= 18）. Conclusion：Atypical pulmonary tuberculosis and lung cancer in the aged were of characteristics of atypical manifestations in clinic, it had crossed and overlapped each other on the imaging findings.The comprehensive analysis on the imaging examinations combined with fiber bronchoscope,lung puncture biopsy, enhanced CT examination, sputum exfoliative cytologic examination, sputum examination（sputum smear or sputum Culture）, diagnostic anti-TB treatment and clinical manifestation,will be helpful for differential diagnosis with atypical pulmonary tuberculosis and lung cancer in the aged.

关 键 词：老年人 肺结核 肺癌 误诊 体层摄影术 

分 类 号：R81[医药卫生—放射医学]