肺炎型肺癌误诊的几点思考  

Some Thoughts on Lung Cancer of Type Pneumonia Misdiagnosed

作　　者：黄科峰[1] 伍晓刚[1] 朱安平[1] 宋君[1] 王燕 邓辉[1] 甘红波[1] 吴宋军 HUANG Ke-feng;WU Xiao-gang;ZHU An-ping(Department of Radiology,The People＇s Liberation Army 477 Hospital,Xiangyang 441003,Hubei Province,China)

机构地区：[1]解放军477医院放射科,湖北襄阳441003

出　　处：《罕少疾病杂志》2018年第5期30-31,34,共3页Journal of Rare and Uncommon Diseases

摘　　要：目的探讨肺炎型肺癌的临床及影像特征,分析误诊原因,提出防范策略。方法回顾分析10例经病理证实的肺炎型肺癌患者的临床症状体征、实验室检查及CT影像学表现。结果 10例患者病理均为腺癌,CT表现呈外周分布10例,单发病变4例,多发病变6例。病灶内见空气支气管征9例,支气管壁不规则、僵硬、扭曲2例,远端闭塞3例,"空泡征"7例,病灶周围沿肺纹理分布的小结节征3例,增强扫描病灶内见"血管征"6例,合并肺门淋巴结肿大1例。临床表现为咳嗽、咳痰10例,伴胸闷3例,伴胸痛2例,低热1例,无明显症状1例。10例患者均有吸烟史,烟龄20-40年,每天10支-60支。实验室检查肿瘤标志物均无升高,白细胞总数轻度升高4例,中性粒细胞升高6例。结论肺炎肺癌有一定特征,临床易误诊,当临床诊断为肺炎,抗炎治疗无效果时,应高度怀疑肺炎型肺癌的可能,积极安排影像学复查,获取肺部病变动态影像学变化,同时安排纤维支气管镜检查,进行病理学诊断。Objective To study the clinical and imaging features of pneumonia in lung cancer, and analyze the misdiagnosis reasons, put forward on the preventive strategy. Methods Retrospective analysis of 10 cases of pneumonia in patients with lung cancer, which was confirmed by pathology, clinical symptoms and signs, laboratory examination and CT imaging findings. Results 10 patients pathology were adenocarcinoma, 10 cases of CT manifestations in peripheral distribution, single lesions in 4 cases, 6 patients with multiple lesions. Air bronchogram see lesions in 9 cases, bronchial wall is irregular, stiff, and the distortion in 2 cases, distal occlusion in 3 cases, ＂bubble＂ in 7 cases, lesions around the texture distribution of nodules along the lung in 3 cases, enhanced scan lesions in see ＂blood vessels＂ in 6 cases, with pulmonary lymph node enlargement in 1 case. Clinical manifestations of 10 cases of cough, sputum, chest with 3 cases, 2 cases with chest pain, low thermal in 1 case, no obvious symptoms in 1 case. All of 10 patients have smoking history, smoking history 20-40 years, 10 to 60 cigarettes a day. Laboratory tests were no rise of tumor markers, moderately elevated white blood cell total 4 cases, 6 cases increased neutrophils. Conclusion Pneumonia, lung cancer has certain characteristics, clinical showing is often, when the preliminary clinical diagnosis is pneumonia and conventional anti-infective therapy effect is poor, the diagnosis of pneumonia should be questioned, type of lung cancer may be highly suspected pneumonia, should arrange active imaging review, get lung disease changes dynamic imaging, diagnostic difficulties, arrange fiber colonoscopy, pathology diagnosis, get early diagnosis and treatment.

关 键 词：肺癌 误诊 肺炎 思考 

分 类 号：R563.1[医药卫生—呼吸系统]