肺泡微石症15例影像、病理特征及误诊分析  

Imaging and Pathological Features of 15 Cases of Pulmonary Alveolar Microlithiasis and Causes of Misdiagnosis

作　　者：万钰磊 王晓燕 肖继伟 汪波玲 刘瑛 WAN Yu-lei;WANG Xiao-yan;XIAO Ji-wei;WAND Bo-ling;LIU Ying(Department of Radiology,Wuhan NO.6 Hospital Affiliated to Jianghan University,Wuhan 430015,China;Department of Radiology,China Resources WISCO Hospital,Wuhan 430080,China)

机构地区：[1]江汉大学附属医院武汉市第六医院影像科,武汉430015 [2]华润武钢总医院放射科,武汉430080

出　　处：《临床误诊误治》2019年第11期1-5,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨肺泡微石症(pulmonary alveolar microlithiasis, PAM)的影像、病理特征及误诊原因、防范措施。方法对曾误诊的肺泡微石症15例的临床资料进行回顾性分析。结果本组临床症状均以咳嗽和咳痰为主,其中3例伴发热、流涕,1例伴咯血。15例首诊均误诊,误诊时间5~10 d,误诊为粟粒性肺结核10例,尘肺4例,细支气管肺泡癌1例。胸部X线检查双肺野呈毛玻璃状或面纱征改变,胸部CT检查双肺野出现磨砂玻璃样、虚线征或白线征改变。本组9例行穿刺活组织病理检查、6例行纤维支气管镜检查确诊PAM,其中2例行肺泡灌洗术,但效果不佳。15例临床治疗均以控制症状、对症支持治疗及稳定病情为主,恢复良好;随访9个月~5年,预后均较好。结论 PAM影像学表现具有特征性,对本病诊断及鉴别诊断有极为重要的作用。Objective To explore the imaging and pathological features, causes of misdiagnosis and preventive measures of pulmonary alveolar microlithiasis(PAM). Methods The clinical data of 15 cases of misdiagnosed PAM were retrospectively analyzed. Results The clinical symptoms of this group were mainly cough and expectortion, including 3 cases with fever and runny nose, and 1 case with hemoptysis. All the 15 cases were misdiagnosed, and the duration of misdiagnosis was 5-10 d. There was misdiagnosis as miliary tuberculosis in 10 cases, pneumoconiosis in 4 cases, and bronchioloalveolar carcinoma in 1 case. Chest X-ray showed ground glass attenuation or veil’s sign in both lungs, and the chest CT examination showed ground glass attenuation, dotted line sign or white line sign. In this group, 9 patients underwent puncture biopsy and 6 patients underwent fiberoptic bronchoscopy to confirm PAM. Two of them underwent alveolar lavage, but the effect was far from satisfactory. The clinical treatment of 15 cases mainly included controlling symptoms, symptomatic and supportive treatment and stablization of disease, and patients recovered well. In addition, the prognosis was good after 9 months to 5 years of follow-up. Conclusion PAM has characteristic imaging signs, which plays an extremely important role in the diagnosis and differential diagnosis of this disease.

关 键 词：肺泡微石症 放射摄影术 体层摄影术 螺旋计算机 误诊 结核 肺 尘肺 

分 类 号：R563[医药卫生—呼吸系统]