误诊为肺结核的黏液嵌塞型ABPA1例并文献复习  

Mucus impaction ABPA misdiagnosed as tuberculosis：one case report and literature review

作　　者：李增艳[1] 卜小宁[1] 谢建新 刘国梁[3] 代华平[1] 

机构地区：[1]首都医科大学附属北京朝阳医院呼吸与危重症医学科北京呼吸疾病研究所,100020 [2]河北省三河市优抚医院,065200 [3]首都医科大学附属北京同仁医院综合科,100730

出　　处：《国际呼吸杂志》2014年第4期250-253,共4页International Journal of Respiration

摘　　要：目的通过对1例误诊为肺结核的变态反应性支气管肺曲霉菌病（allergicbronchopulmonaryaspergillosis，ABPA）患者进行病例总结，提高对黏液嵌塞型ABPA的认识。方法分析1例误诊为肺结核的黏液嵌塞型ABPA患者，尤其是全面回顾其影像学动态改变。结果患者为青年女性，临床主要表现为咳嗽、咳黄色块状痰，偶有喘息，早期肺高分辨率CT呈右肺中叶肿块影，诊断为肺癌合并阻塞性肺炎，抗炎治疗3周后，原肿块影有所减小，但其他部位出现新发斑片影，遂排除肿瘤后予经验性抗结核治疗。定期行肺CT检查，肺部阴影吸收不明显。规律抗结核治疗2．5年后，双上肺出现新发斑片影，故来北京朝阳医院就诊，完善检查示外周血嗜酸粒细胞明显增高，血清总IgE1151kU／L，烟曲霉特异性抗体（＋＋＋），气道激发试验强阳性，肺CT示中心性支气管扩张，远端黏液嵌塞。为典型黏液嵌塞型ABPA病例。结论早期黏液嵌塞型ABPA由于其影像学上不易发现中心性支气管扩张，易被误诊为肿瘤或结核。若合并喘息、痰液黏稠或经验性抗结核治疗不满意，应高度警惕本病可能。Objective To improve the diagnosis of mucus impaction allergic bronchopulmonary aspergillosis （ABPA）. Methods The clinical data of one patient with mucus impaction ABPA who had been misdiagnosed as tuberculosis were analyzed, especially the characteristics of dynamical changes of chest imaging were summarized. Results The clinical features of the patient were cough, expectoration of yellow mucus in blocks, and wheezing. Chest high-resolution computed tornography （HRCT） showed a mass with an irregular shape in the right middle lung lobe. The young female patient was diagnosed with lung cancer companied with obstructive pneumonia. After antibiotic therapy for three weeks, some new patch shadows appeared while the original mass shrunk. After exclusion of lung cancer, the patient was given empirical anti-tuberculosis treatment for two and a half years,meanwhile,the periodically examined HRCT showed no obvious absorption of the shadows and new patch shadows in both upper lung lobes were found. So the patient went to Beijing Chaoyang hospital to perfect the further investigations. The results showed that the eosinophils in peripheral blood significantly elevated, the serum total IgE was 1 151 kU/L, aspergillus fumigatus specific antibodies （＋＋＋）, bronchial challenge test was strongly positive,and tung CT showed central bronchiectasis with distal mucus impaction. Accordingly,the patient was diagnosed with mucus impaction ABPA. Conclusions Mucus impaction ABPA is difficult to diagnose due to central bronchiectasis is not apparent in early chest imaging, and always misdiagnosed as lung cancer or tuberculosis. For patients with wheezing, sticky sputum or when empirical anti-tuberculosis treatment shows no effects,we should be aware of the diagnosis of mucus impttction ABPA.

关 键 词：变态反应性支气管肺曲霉菌病 黏液嵌塞 误诊 

分 类 号：R519[医药卫生—内科学]