肺腺癌误诊为肺结核的原因分析  

Causes of Pulmonary Adenocarcinoma Misdiagnosed as Pulmonary Tuberculosis

作　　者：裴文杰[1] 苏景瑞[1] FEI Wen-jie;SU Jing-rui(Department of Radiology,the Third Hospital of Qinhuangdao City,Qinhuangdao,Hebei 066000,China)

机构地区：[1]秦皇岛市第三医院放射科,河北秦皇岛066000

出　　处：《临床误诊误治》2022年第4期9-12,共4页Clinical Misdiagnosis & Mistherapy

基　　金：2020年秦皇岛市科学技术研究与发展计划项目(202004A045)。

摘　　要：目的探讨肺腺癌误诊为肺结核的原因并总结防范误诊措施,以降低临床误诊率。方法回顾性分析2018年3月—2019年4月肺腺癌误诊为肺结核14例的临床资料。结果14例均有肺结核病史,有吸烟史8例;均以咳嗽、胸痛、咳痰、气短、夜间盗汗、乏力为主要表现,咯血丝痰4例,声音嘶哑1例。14例CT检查在既往结核钙化灶附近发现孤立结节型新病灶,呈圆形及类圆形,边缘呈分叶状及毛刺状各7例,均见胸腔少量弧形液性影。外院因患者在陈旧结核病灶周边出现新病灶,且有结核中毒症状,并结合结核病史诊断为肺结核复发,本组误诊时间为2~7个月。诊断后均给予四联抗结核治疗,病情未见明显好转。遂行胸部增强CT扫描病灶明显强化,且胸腔积液呈血性,细胞学检查找到肿瘤细胞,经纤维支气管镜活组织病理检查诊断为肺腺癌(腺泡细胞癌及乳头状腺癌各7例)。确诊后因患者经济原因拒绝手术或转上级医院治疗,后失访。结论肺腺癌临床易误诊为肺结核,熟知二者临床及影像学特征,仔细鉴别诊断,及时行增强CT扫描、纤维支气管镜活组织病理检查及胸腔积液细胞学检查,可减少临床误诊误治的发生。Objective To explore causes of pulmonary adenocarcinoma misdiagnosed as pulmonary tuberculosis and to summarize the measures to prevent misdiagnosis so as to reduce misdiagnosis rate in clinic.Methods Clinical data of 14 patients with pulmonary adenocarcinoma misdiagnosed as pulmonary tuberculosis between March 2018 and April 2019 was retrospectively analyzed.Results All the 14 patients had a history of pulmonary tuberculosis,and 8 patients had a history of smoking.The main manifestations were cough,chest pain,expectoration,shortness of breath,night sweats and fatigue,and there were hemoptysis in 4 patients and hoarseness in 1 patient.CT scan for the 14 patients found new solitary nodular lesions near the previous tuberculosis calcifications,which were round or sub-round with lobulated and burr-shaped edges in 7 patients,and a small amount of arc-shaped liquid shadows in the thoracic cavity was found in all patients.In the other hospitals,patients had new lesions around the old tuberculosis lesions with symptoms of tuberculosis poisoning,and they were diagnosed as recurrence of pulmonary tuberculosis combined with the history of tuberculosis.The misdiagnosed duration in this group was 2 to 7 months.All patients were given quadruple anti-tuberculosis treatments after diagnosis,and the conditions did not improve significantly.Contrast-enhanced CT scan of the chest showed that the lesions were obviously enhanced,and the pleural effusion was bloody.Cytological examination revealed tumor cells,and pulmonary adenocarcinoma(7 patients with acinar cell carcinoma and 7 patients with papillary adenocarcinoma)was diagnosed by pathological examinations of fiberoptic bronchoscopy for living tissues.After confirming diagnosis,patients gave up surgery due to economic reasons or were transferred to a higher-level hospital for treatment,and all were lost to follow-up.Conclusion Pulmonary adenocarcinoma is more likely to be misdiagnosed as pulmonary tuberculosis in clinical practice.Familiarity with the clinical and imaging featur

关 键 词：肺肿瘤 腺癌 误诊 结核 肺 

分 类 号：R734.2[医药卫生—肿瘤]