结节病七例误诊分析  

Misdiagnosis Analysis of Seven Cases of Sarcoidosis

作　　者：熊鑫[1] 李秀业[1] 刘领[1] 何彦侠[1] 杨霁[1] 吴文杰[1] 薛兵[1] XIONG Xin;LI Xiu-ye;LIU Ling;HE Yan-xia;YANG Ji;WU Wen-jie;XUE Bing(Department of Respiratory Medicine,Beijing Chuiyangliu Hospital,Beijing 100022,China)

机构地区：[1]北京市垂杨柳医院呼吸内科,北京100022

出　　处：《临床误诊误治》2020年第9期6-10,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨结节病的临床特点、误诊原因及防范措施。方法回顾性分析我院收治的误诊为其他疾病的7例结节病的临床资料。结果本组临床表现为咳嗽、咳痰4例,干咳2例,胸闷、眼红、流泪1例;查体可闻及呼吸音减低1例,双肺湿啰音2例,锁骨上淋巴结增大5例。浅表淋巴结超声检查显示,锁骨上淋巴结增大5例,其中2例为单侧增大。胸部CT检查显示,肺门淋巴结增大5例;双肺结节影6例;表现为高密度团片影、磨玻璃结节各2例,合并条索影并小叶间隔增厚与支气管血管束增粗、弥漫小结节影、肺门肿块影各1例。本组误诊时间4周~2年,误诊为肺结核3例,肺炎2例,肺间质纤维化、淋巴瘤合并关节炎各1例。4例双侧肺门淋巴结明显增大经超声内镜引导下支气管针吸活检确诊为结节病;2例存在典型黏膜结节样变经支气管镜黏膜活检确诊为结节病;1例经由锁骨上淋巴结穿刺活检联合皮肤活检确诊为结节病。6例予糖皮质激素治疗,其中3例病情好转后复发;临床观察1例,随访1.5年,病情平稳,无进展。结论结节病可同时累及多个脏器,临床表现无特异性,易误漏诊。提示临床各学科医师应提高对结节病的警惕性,相互协作,从而减少误漏诊。Objective To explore the clinical features,causes of misdiagnosis and preventive measures of sarcoidosis.Methods The clinical data of 7 cases of sarcoidosis misdiagnosed as other diseases in our hospital was retrospectively analyzed.Results The clinical manifestations were cough and sputum in 4 cases,dry cough in 2 cases,and chest tightness,red eyes and weeping in 1 case respectively.Physical examination showed reduced breath sounds in 1 case,rales in both lungs in 2 cases and supraclavicular lymph nodes in 5 cases.Ultrasonography of superficial lymph nodes showed that supraclavicular lymph nodes were enlarged in 5 cases,including 2 cases of unilateral enlargement.Chest CT showed 5 cases of hilar lymph node enlargement and 6 cases of bilateral pulmonary nodules,2 cases of high-density mass shadows and 2 cases of ground glass nodules based on manifestations,1 case of nodules combined with strip shadows and thickening of interlobular septa and thickening of bronchovascular bundles,1 case of diffuse nodules,and 1 case of hilar mass shadows.The duration of misdiagnosis in this group ranged from 4 weeks to 2 years,including 3 cases of pulmonary tuberculosis,2 cases of pneumonia,and 1 case of pulmonary fibrosis,lymphoma and arthritis respectively.Four patients with significantly enlarged bilateral hilar lymph nodes were diagnosed as sarcoidosis by endoscopic ultrasonography-guided transbronchial needle biopsy.Two patients with typical mucosal nodular degeneration were diagnosed as sarcoidosis by bronchoscopy mucosal biopsy,and 1 of them was confirmed as sarcoidosis by pathological examination combined with supraclavicular lymph nodes.Sarcoidosis was confirmed in 1 case by supraclavicular lymph node biopsy combined with skin biopsy.Six patients were treated with glucocorticoid,3 of whom had relapse after improvement.One case was clinically observed and followed up for 1.5 years,with stable disease and no progression.Conclusion Sarcoidosis can involve multiple organs simultaneously,and its non-specific clinical manifesta

关 键 词：结节病 误诊 结核 肺 肺炎 肺疾病 间质性 淋巴瘤 关节炎 

分 类 号：R593.9[医药卫生—内科学]