左肺结核伴纵隔淋巴结结核经^(18)氟-脱氧葡萄糖正电子发射断层扫描术误诊肺癌淋巴结转移  

Le Pulmonary and Mediastinal Lymphnode Tuberculosis Misdiagnosed as Lymphatic Metastasis from Lung Cancer on 18- uoro-deoxy-glucose-positron emission tomography

作　　者：刘焱斌[1] 杨彦佳[1] 李雅馨[1] 刘凯[1] 

机构地区：[1]四川大学华西医院感染性疾病中心,成都610041

出　　处：《华西医学》2012年第10期1474-1477,共4页West China Medical Journal

摘　　要：目的探讨结核病在18氟-脱氧葡萄糖(18F-FDG)正电子发射断层扫描术(PET)中的影像学表现,提高对PET/CT在肺部包块诊断作用的认识,减少误诊。方法回顾分析2010年3月收治的1例肺结核合并纵隔淋巴结结核病患者的误诊及诊断治疗经过,分析误诊原因并总结诊治经验,结合文献复习肺部包块在PET/CT中的表现及临床特点。结果患者为肺部包块伴纵隔淋巴结包块,胸部CT提示肺癌伴纵隔淋巴结转移,PET/CT也考虑左肺下叶肺癌伴淋巴结转移。最后经纵隔镜淋巴结活检确诊结核,并抗结核治疗好转。结论结核等感染性疾病常可导致18F-FDG的摄取增加而造成PET/CT阳性结果,因此在18F-FDG PET/CT呈现阳性结果时须注意鉴别病变良恶性,其中高标准摄入值包块尤其需要注意与结核病相鉴别。Objective To explore the imaging finding of tuberculosis in 18-fluoro-deoxy-glucose （18F-FDG）-positron emission tomography （PET） and enhance the cognition to the diagnostic role of PET/CT on pulmonary mass to reduce misdiagnosis. Methods We reviewed the process ofmisdiagnosis, diagnosis and treatment in one patient with pulmonary and mediastinal lymphnode tuberculosis treated in 2010, analyzed the misdiagnosis reasons, and summarized the experiences of diagnosis and treatment. Furthermore, related literatures were reviewed on PET/CT imaging findings and clinical characteristics of pulmonary masses. Results The patient presented with pulmonary mass with mediastinal lymphnode mass. Both chest CT and PET/CT suggested lung cancer in left lobus inferior pulmonis with mediastinal lymph node metastasis. Finally, tuberculosis was confirmed by lymphnode biopsy through mediastinoscope and alleviated after anti-tuberculosis therapy. Conclusions Tuberculosis and other infectious diseases may lead to the increasing uptake of 18F-FDG, which can cause a positive result in PET/CT. Accordingly, we should distinguish between benign and malignant lesions when 18F-FDG PET / CT shows positive results. Especially, the high-standardized uptake value mass should be distinguished from tuberculosis.

关 键 词：结核 正电子发射断层扫描 18氟-脱氧葡萄糖 

分 类 号：R521[医药卫生—内科学]