影像学表现无特异性的变应性支气管肺曲霉菌病误诊分析  

Misdiagnosis Analysis of Allergic Bronchopulmonary Aspergillosis with Non⁃specific Imaging Findings

作　　者：贾卫红 祝阿妮 路晨阳 马倩[1] 卜丽娜 刘志燕 李楠[1] 杨栋才 JIA Weihong;ZHU Ani;LU Chenyang;MA Qian;BU Lina;LIU Zhiyan;LI Nan;YANG Dongcai(Department of Respiratory and Critical Care Medicine,the Affiliated Hospital of Northwest University Xi'an No.3 Hospital,Xi'an 710083,China)

机构地区：[1]西北大学附属医院,西安市第三医院呼吸与危重症医学科,西安710083

出　　处：《临床误诊误治》2023年第5期1-5,共5页Clinical Misdiagnosis & Mistherapy

基　　金：西安市科技局项目[2017113SF/YX007(2)];西安市卫健委项目(2021lyb41,2021lyb42)。

摘　　要：目的总结影像学表现无特异性的变应性支气管肺曲霉菌病(ABPA)的临床特点及诊治方法,以减少误诊误治。方法对2017年2月—2022年12月收治的影像学表现无特异性的ABPA 4例的临床资料进行回顾性分析。结果4例均有长期咳嗽、气喘及气短症状,胸部影像学均缺乏典型的中心性支气管扩张、牙膏征或指套征。外周血嗜酸粒细胞总数、嗜酸粒细胞比例及血清总IgE增高4例。误诊为肺炎、支气管扩张症、支气管哮喘急性发作、慢性阻塞性肺疾病各1例。4例均进行了气管镜检查,支气管肺泡灌洗液及痰培养检查证实肺烟曲霉菌感染2例。4例经临床症状、实验室检查、气管镜检查结果综合分析后明确诊断ABPA,给予糖皮质激素联合抗真菌药物治疗效果均理想。结论无特异性影像学表现的ABPA,临床易误诊。对于以长期咳嗽、咳痰伴气喘症状就诊的患者,临床医生应提高警惕,尽早完善相关检查,以减少误诊漏诊的发生。Objective To summarize the clinical characteristics,diagnosis and treatment of allergic bronchopulmo⁃nary aspergillosis(ABPA)with non⁃specific imaging findings,so as to reduce misdiagnosis and mistreatment.Methods The clinical data of 4 cases of ABPA with non⁃specific imaging findings admitted from February 2017 to December 2022 were retro⁃spectively analyzed.Results All the 4 patients had chronic cough,asthma and shortness of breath,and lacked typical cen⁃tral bronchiectasis,toothpaste sign or finger sleeve sign on chest imaging.The total number of peripheral blood eosinophils,the proportion of eosinophils and serum total IgE increased in 4 cases.They were misdiagnosed as pneumonia(n=1),bron⁃chiectasis(n=1),acute attack of bronchial asthma(n=1)and chronic obstructive pulmonary disease(n=1).Tracheosco⁃py was performed in all 4 cases,and bronchoalveolar lavage fluid and sputum culture examination confirmed pulmonary asper⁃gillus fumigatus infection in 2 cases.After comprehensive analysis of clinical symptoms,and results of laboratory examination and tracheoscopy,ABPA was definitely diagnosed in 4 cases,and the effect of glucocorticoid combined with antifungal drugs was favorable.Conclusion ABPA without specific imaging findings is prone to clinical misdiagnosis.For patients with chro⁃nic cough and sputum accompanied by asthma,clinicians should be vigilant and improve relevant examinations as soon as pos⁃sible to reduce the occurrence of misdiagnosis and missed diagnosis.

关 键 词：曲霉菌病 变应性支气管肺 误诊 肺炎 支气管扩张症 哮喘 肺疾病 慢性阻塞性 嗜酸细胞 支气管镜检查 

分 类 号：R519.9[医药卫生—内科学]