胺碘酮致间质性肺疾病误诊为社区获得性肺炎  

Amiodarone Induced Interstitial Lung Disease Misdiagnosed as Community Acquired Pneumonia

作　　者：方苏榕[1] 孙丽华[1] 谷伟[1] 

机构地区：[1]南京医科大学附属南京医院呼吸内科,南京210006

出　　处：《临床误诊误治》2012年第11期22-25,共4页Clinical Misdiagnosis & Mistherapy

基　　金：国家自然科学基金(81100010)

摘　　要：目的探讨胺碘酮肺毒性的临床特点及误诊原因,并提出防范措施。方法回顾性分析1例胺碘酮致间质性肺疾病误诊为社区获得性肺炎的临床资料。结果患者因咳嗽伴气喘10 d就诊,门诊X线胸片提示右肺感染,入院诊断为社区获得性肺炎。行经验性抗感染治疗,3 d后患者出现发热。查体肺部可闻及较明显Velcro啰音。胸部CT检查示:右肺各叶均有不规则片状毛玻璃影,上叶前段有肺泡渗出影。考虑肺部病变涉及多个肺叶,调整抗生素,患者体温降至正常,但出现呼吸衰竭。经复习原住院病案并追询病史,了解到患者长期口服胺碘酮。肺功能检查提示限制性通气功能障碍。诊断考虑胺碘酮肺毒性致间质性肺疾病,加用糖皮质激素等治疗,症状改善,肺部病变明显吸收,病情好转出院。结论应用胺碘酮者出现间质性肺炎时应警惕胺碘酮肺毒性,双侧肺间质病变不对称为其特点,仔细了解用药史是确立诊断依据,高分辨率CT检查有助于诊断。Objective To explore clinical features and misdiagnosed causes of amiodarone pulmonary toxicity in order to propose preventive measures. Methods Clinical data of 1 patient with amiodarone induced interstitial lung disease misdiagnosed as community acquired pneumonia was retrospectively analyzed. Results The patient was admitted for cough and asthma for 10 days, infection in right lung by chest x-ray film and diagnosed as having community acquired pneumonia. The patient ran a fever 3 days after experien- tial anti-infective therapy. There was obviously Velcro rale in bellows in physical check-up. There were anomalous lamellar clouded glass shadow in right lung and pulmonary alveolus exudate shadow in front of lobus superior in chest CT examination. The use of antibiotics was adjusted for lung pathological change in several lobes of Lung, the patient＇body temperature was normal but the patient suffered respiratory failure. By reviewing hospital medical record and inquiring into medical history we learned that the patient had a long-term oral amiodarone history. Restrictive ventilatory functional disturbance was prompted by pulmonary function test. Clinical diagnosis was amiodarone induced interstitial lung disease. Patient＇s symptoms improved after glucocorticoid therapy and the lung lesion was absorbed, and the patient was discharged after his condition improved. Conclusion Patients＇with interstitial pneumonia using oral Amiodarone should be wary of amiodarone induced pulmonary toxicity. Interstitial lesions in the bilateral and asymmetry lung are characteristics. Medication history should be carefully studied, and diagnosis should be based on HRCT examination.

关 键 词：胺碘酮 肺疾病 间质性 误诊 社区获得性感染 

分 类 号：R595.3[医药卫生—内科学]