成人支气管异物长期误诊1例并文献复习  

Long-term misdiagnosis of adult with bronchial foreign body ： a case report and literature review

作　　者：程洋[1] 王艳霞[1] 张运剑[1] 夏国光[1] 

机构地区：[1]北京积水潭医院呼吸内,北京100035

出　　处：《国际呼吸杂志》2012年第12期919-922,共4页International Journal of Respiration

摘　　要：目的提高对成人支气管异物的认识和诊治水平，避免长期误诊、误治。方法回顾我院收治的1例长期误诊支气管异物成年患者病历资料，并复习相关文献，探讨成人支气管异物在临床症状、胸部影像学及支气管镜下的不典型表现以及造成患者长期误诊、误治的原因。结果成年患者，近4年反复咳嗽、咯痰、喘憋，影像学上有弥漫性磨玻璃影、多发支气管扩张及斑片影等多种表现，曾行支气管舒张试验阳性，严重时曾行气管插管，入我院后行支气管镜检查确诊为右中间段支气管异物，后长期随访患者临床表现、影像学及肺功能检查已治愈。结论成年患者常无明确异物吸人史，临床症状不典型，影像学常无异物存在直接征象，容易造成临床误诊、误治，支气管镜对成人支气管异物的诊治有重要价值。Objective To improve the understanding,diagnosis and treatment of adult patient with bronchial foreign body, avoiding long-term misdiagnosis and inappropriate treatment. Methods The clinical data of one adult patient with bronchial foreign body misdiagnosed for four years was analyzed retrospectively. Literature was reviewed. The atypical clinical manifestation,imaging and bronchoscopy of patient with bronchial foreign body were explored. The causes of long-term misdiagnosis and inappropriate management of bronchial foreign body were discussed. Results The clinical manifestation of one adult patient included recurrent cough, sputum and wheezing. CT scan showed diffuse ground-glass opacity, multiple bronchiectasis and patch shadow. Bronchial dilation test was positive. Tracheal intubation was underwent in extreme case. Bronchoscopy indicated right middle segmental bronchial foreign body. The symptoms were relieved greatly by removing the foreign body and proper medications, and the imaging and pulmonary function tests were also improved during a long-term follow-up. Conclusions Absent of foreign body inhaling history,atypical clinical symptoms and imaging features are main causes of misdiagnosis and inappropriate management in adult patients. Bronchoscopy plays an important role in the diagnosis and treatment of bronchial foreign body in adults.

关 键 词：支气管异物 误诊 支气管镜 

分 类 号：R768.13[医药卫生—耳鼻咽喉科]