36例老年肺结核误诊情况分析  

Analysis of misdiagnosis in 36 elderly patients with pulmonary tuberculosis

作　　者：叶龙玲 李双初 程芝 郭玉霞 王俊 陈红璋 Long-ling YE;Shuang-chu LI;Zhi CHENG;Yu-xia GUO;Jun WANG;Hong-zhang CHEN(Inpatient Department of Xiaogan Institute for TB Prevention and Control, Xiaogan 432000, China)

机构地区：[1]湖北省孝感市结核病防治所住院部,432000 [2]湖北省孝感市结核病防治所门诊部,432000

出　　处：《结核病与肺部健康杂志》2018年第4期328-331,共4页Journal of Tuberculosis and Lung Health

摘　　要：为探讨老年肺结核的误诊原因,笔者回顾性分析2012年10月至2018年9月孝感市结核病防治所收住入院的36例≥60岁老年肺结核患者的临床资料,其中11例由本所误诊,25例来本所住院之前由综合医院误诊。在36例老年肺结核中,4例结核瘤误诊为周围型肺癌,5例支气管结核误诊为支气管哮喘,4例支气管结核伴肺不张误诊为中央型肺癌,1例支气管结核伴肺不张误诊为炎性肺不张,2例急性血行播散性肺结核误诊为肺泡癌,5例干酪性肺炎误诊为大叶性肺炎,3例以间质改变为主的肺结核误诊为间质性肺炎,3例空洞内可见液平的肺结核误诊为肺脓肿,4例团块状肺部阴影伴厚壁不规则空洞性肺结核误诊为肺癌,5例顽固性结核性胸腔积液误诊为癌性胸腔积液。老年肺结核由于临床特征不典型,容易误诊,故临床医生应予以足够重视。In order to explore the reasons of misdiagnosis in elderly patients with pulmonary tuberculosis (PTB), this paper retrospectively analyzed the clinical data of 36 elderly PTB patients aged 60 years and above who were admitted to stay at Xiaogan Institute for TB Prevention and Control from October 2012 to September 2018 and received treatment. Of which 11 cases were misdiagnosed by the institute while the remaining 25 cases were misdiagnosed by the general hospitals before they came to the institute. Among those 36 elderly PTB cases, 4 cases with tuberculoma were misdiagnosed as peripheral lung cancer, 5 cases with bronchial tuberculosis were misdiagnosed as bronchial asthma, 4 cases with bronchial tuberculosis and atelectasis were misdiagnosed as central lung cancer, 1 case with bronchial tuberculosis and atelectasis was misdiagnosed as inflammatory atelectasis, 2 cases with hematogenous disseminated pulmonary tuberculosis were misdiagnosed as alveolar carcinoma, 5 cases with caseous pneumonia were misdiagnosed as lobar pneumonia, 3 cases with interstitial tuberculosis were misdiagnosed as interstitial pneumonia, 3 cases had pulmonary tuberculosis with fluid filling were misdiagnosed as pulmonary abscess, 4 cases had PTB with mass shadow and thick-walled irregular cavity were misdiagnosed as lung carcinoma, 5 cases with intractable tuberculous pleural effusion were misdiagnosed as malignant pleural effusion. Due to the atypical clinical features in elderly patients with pulmonary tuberculosis, it is very easy to be misdiagnosed, so clinicians should pay enough attentions to it.

关 键 词：结核 肺 老年人 误诊 疾病特征 

分 类 号：R521[医药卫生—内科学]