不明原因颈部脓肿误诊致感染性休克1例  

A case of septic shock caused by misdiagnosis of unknown neck abscess

作　　者：庞燕 李培杰[1] PANG Yan;LI Peijie(Department of Critical Care Medicine,Lanzhou University Second Hospital,Gansu Province,Lanzhou730030,China)

机构地区：[1]兰州大学第二医院重症医学科,甘肃兰州730030

出　　处：《中国医药导报》2021年第29期185-188,共4页China Medical Herald

基　　金：甘肃省自然科学研究基金计划项目(18JR3RA313)。

摘　　要：颈部脓肿多由牙源性和咽源性感染引起,一般伴有原发感染症状。缺乏典型症状且与周围组织分界不清时容易误诊。本文介绍1例兰州大学第二医院2020年6月7日收治的病例。患者,男,30岁,以颈部疼痛性包块为首发症状,误诊为"化脓性甲状腺炎",初始抗感染疗效差,入院后通过进一步影像学及病原学检查确诊为牙源性感染导致的颈部脓肿,通过抗感染联合外科引流好转。本例症状不典型,未考虑到化脓性甲状腺炎的低发病率及其病因,且忽视了口腔牙周疾病,导致误诊。本文结合病例资料,对颈部脓肿和化脓性甲状腺炎进行鉴别,旨在减少误诊。今后遇到不明原因颈部脓肿时,需警惕牙周病原体,为不明原因颈部脓肿诊疗提供思路。Neck abscesses are mostly caused by odontogenic and pharyngeal infections,usually accompanied by primary infection symptoms.It is easy to be misdiagnosed when there are no typical symptoms and no clear boundary between them and surrounding tissues.This article introduces a case admitted to Lanzhou University Second Hospital on June 7,2020.The patient,male,30 years old,presented painful neck mass as the initial symptom and was misdiagnosed as "suppurative thyroiditis".The initial anti-infection effect was poor,but after admission,the patient was diagnosed as neck abscess caused by odontogenic infection through further imaging and etiological examination,which was improved by anti-infection combined with surgical drainage.The symptoms of this case were not typical,and the low incidence of suppurative thyroiditis and its etiology were not taken into account,and oral periodontal diseases were ignored,leading to misdiagnosis.In order to reduce misdiagnosis,this article differentiates neck abscess from suppurative thyroiditis.In the future,it is necessary to guard against periodontal pathogens when encountering neck abscess of unknown cause,and provide ideas for the diagnosis and treatment of unknown neck abscess.

关 键 词：颈部脓肿 化脓性甲状腺炎 误诊 感染性休克 

分 类 号：R653[医药卫生—外科学]