肺胸疾病影像学误诊的教训和对策(附100例分析)  

An Analysis of Imaging Misdiagnosis About Lung and Chest Diseases (An Analysis of 100 Cases)

作　　者：张振峰[1] 张承惠[2] 吴沛宏[1] 张伟章[1] 阮超美[1] 郑列[1] 李家尧[1] 伍尧泮[1] 蔡培强[1] 

机构地区：[1]中山大学肿瘤防治中心影像介入科,广东广州510060 [2]孙逸仙纪念医院放射科

出　　处：《实用放射学杂志》2002年第9期758-760,共3页Journal of Practical Radiology

摘　　要：目的　总结肺胸疾病影像学误诊的原因和经验教训 ,以期提高对疑难疾病和罕见疾病的鉴别诊断能力 ,以减少误诊。方法　收集手术 (活检 )病理或临床确诊的X线、CT、MRI和介入活检曾误诊的肺胸疾病 10 0例 ,回顾性分析其误诊原因。结果　肺胸疾病影像学总误诊率为 15 .6%。 (1)误诊病种 :肺癌最多见 ,其次是肺结核球 ,炎性假瘤 ,良性肿瘤或囊肿 ,少见病有肺肉瘤、肺淀粉样变、高位肺段隔离症及横膈病变等。 (2 )误诊的主客观原因有四种 :①观察分析欠准确有 18例 ;②病灶形态不典型或属罕少见疾病共 2 7例 ;③没有及时运用CT增强扫描等较新技术致误诊 3 0例 ;④诊断思维上的孤立片面性为主因 2 5例。结论　从以下四个方面来努力降低误诊率 ,提高正确诊断率 :(1)坚持以传统X线照片和透视为基础 ,同时注意应用能进一步揭示病变本质的其他手段如CT等。 (2 )认真磨练基本功 ,不断积累病例诊断正反两方面的经验 ,提高发现病变和分析鉴别诊断的能力。 (3 )坚持影像密切结合临床资料的综合诊断方法 ,注意形态与功能的联系。 (4 )对未能作出确诊或鉴别的病例 。Objective By summarizing the causes of imaging misdiagnosis of lung and chest diseases,to improve the abilities in detecting and distinguishing diseases of lung and chest.Methods 100 cases of lung and chest diseases proved by pathology or clinic and misdiagnosed by X-ray,CT,MRI and interventional biopsy in past five years were presented in this paper.The imaging misdiagnostic cause of all cases were analysed retrospectively.Results The total imaging misdiagnostic rate of lung and chest diseases was 15.6%. (1)The kinds of misdiagnosis included: pulmonary carcinoma (45 cases); pulmonary inflammatory pseudotumor(12 cases); tuberculoma(15 cases); benign tumor and cyst(8 cases); and other rare diseases(20 cases). (2)The causes of misdiagnosis included: (a) Inexactly observing and analyzing (18 cases); (b) Atypical lesions or rare diseases (27 cases); (c) Not timely utilized new imaging techniques such as CT or enhanced CT (30 cases);d, One-sided thinking on diagnosis(25 cases). Conclusion It is necessary to decrease imaging misdiagnostic rate of lung and chest disesases as followings: (1)Keepping up the basis of conventional fluoroscopy and X-ray film. (2)Accumulating the basic imaging diagnostic experiences step by step, and increasing capacities of detecting and differentiating diseases. (3)Insisting on combining closely imaging with clinical data, and paying much attention to relationships between morphology and function. (4)To recommend the further efficient examination for undetermined lesions.

关 键 词：肺疾病 胸疾病 影像学诊断 误诊 肺癌 肺结核病 炎性假瘤 误诊原因 

分 类 号：R734.2[医药卫生—肿瘤] R521[医药卫生—临床医学]