以右肺中叶肺不张、肺实变为主要影像表现的老年女性支气管色素沉着纤维化延迟诊治分析  

Analysis of Delayed Diagnosis and Treatment of Bronchial Anthracofibrosis in Elderly Women with Right Middle Lobe Atelectasis and Pulmonary Consolidation

作　　者：贾卫红 祝雅 杨栋才 刘瑞娟 卜丽娜 刘志燕 杨倩[2] JIA Weihong;ZHU Ya;YANG Dongcai;LIU Ruijuan;BU Lina;LIU Zhiyan;YANG Qian(Department of Respiratory and Critical Care Medicine,Xi'an No.3 Hospital the Affiliated Hospital of Northwest University,Xi'an 710083,China;Department of Anesthesiology,Xi'an No.3 Hospital the Affiliated Hospital of Northwest University,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 [2]西北大学附属医院西安市第三医院麻醉科,西安710083

出　　处：《临床误诊误治》2024年第7期6-11,共6页Clinical Misdiagnosis & Mistherapy

基　　金：西安市第三医院院级医学研究项目(Y2023yxyj04)。

摘　　要：目的分析以右肺中叶肺不张、肺实变为主要影像表现的支气管色素沉着纤维化(BAF)患者临床特点、误诊原因。方法回顾分析2023年1—12月收治的5例以右肺中叶肺不张、肺实变为主要影像学表现且经气管镜确诊的老年BAF患者的诊治过程。结果5例老年女性,年龄67~75岁,长期生活在农村,有常年生物燃料使用史。5例以慢性咳嗽、胸闷、活动后气短为主要临床表现,胸部CT提示右肺中叶肺不张3例、右肺中叶肺实变2例,2例有高血压基础疾病,5例均无吸烟史。误诊为肺炎1例,支气管哮喘1例,慢性支气管炎1例,慢性阻塞性肺疾病1例,肺占位性病变1例。5例最终经气管镜确诊为BAF,误诊时间2 d~20年,5例接受双支气管扩张剂吸入及对症支持等治疗,均好转出院。结论BAF早期无特异性症状,实验室和影像学检查无特异性,容易误漏诊。确诊该病需要依靠病史、临床、影像学、气管镜检查综合判断。对于既往常年使用生物燃料烹饪、取暖,影像学检查提示以右肺中叶肺不张、右肺中叶肺实变影为主要征象的老年女性患者,一定要行气管镜检查,排除BAF可能。Objective To analyze the clinical characteristics and causes of misdiagnosis of bronchial anthracofibrosis(BAF)in patients with right middle lobe atectasis and pulmonary consolidation.Methods The diagnosis and treatment of 5 elderly BAF patients with right middle lobe atelectasis and pulmonary consolidation as the main imaging manifestations and diagnosed by tracheoscopy were retrospectively analyzed from January to December 2023.Results Five elderly women aged 67-75 years lived in rural areas for a long period of time,and had a history of perennial biofuel use.The main clinical manifestations of the 5 patients were chronic cough,chest tightness and shortness of breath after activity.Chest CT showed right middle lobe atectasis in 3 patients,right middle lobe consolidation in 2 patients,basic hypertension in 2 patients,and no smoking history in 5 patients.There was misdiagnosis as pneumonia in 1 patient,bronchial asthma in 1 patients,chronic bronchitis in 1 patient,chronic obstructive pulmonary disease in 1 patient,and lung space occupying lesion in 1 patient.Five patients were finally diagnosed with BAF by tracheoscopy,and the misdiagnosis time lasted 2 d to 20 years.Five patients received dual bronchodilator inhalation and symptomatic supportive treatment,and all were discharged from hospital.Conclusion BAF has no specific symptoms in early stage,no specificity in laboratory and imaging tests,and it is prone to misdiagnosis.The diagnosis of the disease depends on the comprehensive judgment of history,clinical and imaging examination and tracheoscopy.For elderly female patients who have been using biofuels for cooking and heating for years and whose imaging findings suggest right middle lobe atelectasis and right middle lobe consolidation as the main signs,tracheoscopy must be performed to rule out the possibility of BAF.

关 键 词：支气管色素沉着纤维化 误诊 肺炎 哮喘 支气管炎 慢性 肺疾病 慢性阻塞性 诊断 支气管镜 

分 类 号：R562.2[医药卫生—呼吸系统]