以胸腔积液为首发表现的结节病四例  

Sarcoidosis with pleural effusion as the initial manifestation:4 case reports

作　　者：王秀燕[1] 高建梅 张红[1] 王蓓 王绍金[1] WANG Xiuyan;GAO Jianmei;ZHANG Hong;WANG Bei;WANG Shaojin(Ningxia Medical University General Hospital,Yinchuan,Ningxia 750004,P.R.China)

机构地区：[1]宁夏医科大学总医院,宁夏银川750004

出　　处：《中国呼吸与危重监护杂志》2022年第3期185-188,共4页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的探讨以胸腔积液为首发表现的结节病的临床特征、胸部影像学表现和病理改变以及诊治经过,并分析其可能误诊原因,以帮助临床医生提高对以胸腔积液为首发表现的结节病的认识,减少临床误诊及漏诊率。方法回顾性分析宁夏医科大学总医院2019年1月—2020年12月收治的4例以胸腔积液为首发表现的肺结节病变患者的一般资料、临床表现、影像学检查、病理结果、转归情况。结果4例患者中以女性为主,其中,3女1男,平均年龄50.3岁,以咳嗽、咳痰、胸闷、气促等常见呼吸道症状为主要临床特征,胸部CT均提示右侧胸腔积液,入院后行胸腔闭式引流、气管镜、胸腔镜、胸膜活检及颈部淋巴结活检等检查获取病理,结合影像学、病理明确诊断,给予糖皮质激素治疗后症状、影像学好转。结论结节病相关胸腔积液为首发相对少见,临床症状无特异性,胸腔积液理化性质无特异性,病理可见非干酪肉芽肿病变,确诊需要依靠临床、影像和病理进行综合判断,内科治疗大多预后良好。Objective To investigate the clinical features,chest imaging manifestations,pathological changes,diagnosis and treatment of sarcoidosis with pleural effusion as the initial manifestation,and to analyze the possible causes of misdiagnosis,so as to help clinicians improve their understanding of sarcoidosis with pleural effusion as the initial manifestation,and reduce the rate of clinical misdiagnosis and missed diagnosis.Methods The general data,clinical manifestations,imaging examinations,pathological findings and outcomes of 4 patients with sarcoidosis with pleural effusion as the first manifestation admitted to Ningxia Medical University General Hospital from January 2019 to December 2020 were retrospectively analyzed.Results Out of these patients,3 were female and 1 was male,with an average age of 50.3 years.The main clinical features were cough,expectoration,chest tightness,shortness of breath and other common respiratory symptoms.Chest CT indicated right pleural effusion.After admission,closed thoracic drainage,tracheoscopy,thoracoscopy,pleural biopsy and cervical lymph node biopsy were performed to obtain pathology.Combined with imaging and pathology,diagnosis was made.After hormone therapy,symptoms and imaging were improved.Conclusions Sarcoidity-related pleural effusion is relatively rare as the first episode,with no specific clinical symptoms and no specific physical and chemical properties of pleural effusion.Non-caseous granulomatous lesions can be found pathologically,and the diagnosis needs to rely on clinical,imaging and pathological comprehensive judgment.

关 键 词：结节病 胸腔积液 病理活检 

分 类 号：R597[医药卫生—内科学]