不典型肺结核18例临床误诊分析  

Clinical Analysis of 18 Misdiagnosed Patients with Atypical Pulmonary Tuberculosis

作　　者：苏景瑞[1] 裴文杰[1] SU Jing-rui;FEI Wen-jie(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6期1-4,共4页Clinical Misdiagnosis & Mistherapy

基　　金：秦皇岛市科学技术研究与发展计划项目(202004A045)。

摘　　要：目的分析不典型肺结核的临床及影像学表现,探讨引起误诊的原因。方法回顾分析2019年1月—2020年8月收治的不典型肺结核18例的临床资料。结果18例中10例因出现发热、咳痰、结核菌素纯蛋白衍生物试验弱阳性或阴性、X线检查示肺部见大片致密影误诊为肺炎;4例因结核中毒症状不典型、影像学检查见肺部球形块状实变影误诊为肺癌;4例因发热、胸痛、咳痰、白细胞计数增高及影像学检查结果误诊为肺脓肿。误诊时间为7 d~5个月。误诊为肺炎及肺脓肿患者入院后予联合抗感染治疗效果欠佳,会诊后行动态CT增强扫描、多次痰液结核菌检查、纤维支气管镜刷检确诊为肺结核;误诊为肺癌患者入院后拟择期手术治疗,术前行CT引导下经皮肺穿刺活组织病理检查确诊为肺结核。18例确诊后予三联或四联抗结核治疗6~12个月,临床症状明显改善或消失,痰液结核菌检查转阴,影像学表现明显改善,后规律随访未见复发。结论不典型肺结核因临床表现无特异性,影像学表现不典型且复杂多样,误诊率较高。接诊医生应提高对不典型肺结核的认识,熟知其影像学表现,并结合多次痰液结核菌检查、纤维支气管镜刷检、CT引导下经皮肺穿刺活组织病理检查等结果,拓宽诊断思路,全面综合分析病情,尽量减少或避免不典型肺结核的误诊误治。Objective To analyze clinical and imaging manifestations of atypical pulmonary tuberculosis(APT)in order to explore misdiagnosed causes.Methods Clinical data of 18 patients with APT admitted between January 2019 and August 2020 was retrospectively analyzed.Results Among the 18 cases,10 patients were misdiagnosed as having pneumonia because of fever,expectoration,weakly positive or negative results by tuberculin pure protein derivative test,and large dense shadows in the lungs by X-ray examination;4 patients were misdiagnosed as having lung cancer because of atypical symptoms of tuberculosis poisoning and the spherical lumpy consolidation in the lung by imaging examination;4 patients were misdiagnosed as having lung abscess due to fever,chest pain,expectoration,increased white blood cell count and imaging findings.The misdiagnosed duration was 7 d to 5 months.Patients misdiagnosed as having pneumonia or pulmonary abscess were treated with combined anti-infective therapy after admission,and the efficacy was far from satisfactory.After the consultation,dynamic CT enhanced scan,multiple sputum tuberculosis examinations,and fiberoptic bronchoscopy were performed,and then pulmonary tuberculosis was confirmed.Elective surgery was performed on patients who had been misdiagnosed as having lung cancer,and a preoperative CT-guided percutaneous lung biopsy was performed to confirm the diagnosis of pulmonary tuberculosis.All the 18 patients received triple or quadruple anti-tuberculosis treatment for 6 to 12 months after confirming diagnosis,and their clinical symptoms improved or disappeared.Results of sputum Mycobacterium tuberculosis test conversed from positive to negative,and imaging findings significantly improved,and no recurrence was found during regular follow-up.Conclusion APT has a high rate of misdiagnosis due to nonspecific clinical manifestations and atypical and complex imaging manifestations.Doctors should improve their understanding of APT,be familiar with its imaging manifestations,and combine the results of

关 键 词：不典型肺结核 误诊 肺炎 肺脓肿 肺肿瘤 

分 类 号：R521[医药卫生—内科学]