外伤性肺囊肿继发慢性感染误诊为胆固醇性包裹性胸腔积液1例及文献复习  

Secondary infection of traumatic pulmonary cyst misdiagnosed as cholesterol encapsulated pleural effusion:a rare case and review of literature

作　　者：周钱辉 范洁玲 彭红[1] 陈平[1] 

机构地区：[1]中南大学湘雅二医院呼吸内科,长沙410011

出　　处：《中南大学学报（医学版）》2017年第5期591-595,共5页Journal of Central South University ：Medical Science

基　　金：国家自然科学基金(81370164;81670062);湖南省自然科学基金(2015JJ4087)~~

摘　　要：肺囊肿是肺内较为常见的良性病变,当囊肿合并感染时易误诊。中南大学湘雅二医院收治1例外伤性肺囊肿合并慢性感染的患者,此患者最初经胸腔镜活检诊断为胆固醇性胸膜炎,后因病情反复行开胸手术,术中可见一直径10 cm且与胸部、横膈膜紧密粘连的肺内薄壁囊肿,游离囊腔发现蒂部起源于右下肺。病理结果提示为假性囊肿,结合胸部外伤史,考虑为外伤性肺囊肿合并慢性感染,行右侧中下肺叶切除术及纤维板剥脱术后预后良好。胸部外伤10年后才发现的外伤性肺囊肿非常少见,合并胆固醇性囊液者更为少见,巨大肺囊肿合并感染时易误诊为胸腔积液。因而,仔细询问病史对临床医师作出正确诊断及治疗至关重要,此外,对于胸部外伤患者无论有无临床症状都应进行常规影像学检查。Pulmonary cyst is a relatively common benign lesion. It is easy to be misdiagnosed when the cyst complicated with infection. This paper reported a case of a giant traumatic pulmonary cyst （diameter 10 cm） combined with chronic infection. Firstly3 the patient was diagnosed as cholesterol pleurisy after undergoing thoracoscopic biopsy. With repeated pleural effusion, the patient was scheduled for right anterolateral thoracotomy3 which showed a thin-walled cyst （10 cm in diameter） attached to parietal and diaphragm, with the stem of cavity originated from the right lower lobe after the cyst cavity was dissociated. Pathological examination revealed that it was apseudocyst, which could be diagnosed as traumatic pulmonary cyst combined with chronic infection according to history of trauma. After undergoing right lower lobectomy and stripping of fiberboard, the prognosis was good. Traumatic pulmonary cyst, which was discovered interval 10 years after chest trauma, was rare. Traumatic pulmonary cyst combined with cholesterol cystic fluid was very rare. Huge pulmonary cyst complicated with infection was easily misdiagnosed as loculated pleural effusion. Therefore, to be correct diagnosis and treatment, clinician must carefully ask medical history. In addition, early image examination should be considered in those patients with chest trauma whether there are clinical symptoms or not.

关 键 词：外伤性肺囊肿 胆固醇性胸膜炎 胆固醇性胸腔积液 

分 类 号：R563[医药卫生—呼吸系统]