以胸闷和气短为主要症状的肺结节病误诊分析及文献学习  

Misdiagnosis and Literature Review of Pulmonary Sarcoidosis with Chest Tightness and Shortness of Breath as Main Symptoms

作　　者：李梦聪 王娜[1] 王广东 刘婷婷[1] 纪文文 石志红[1] LI Mengcong;WANG Na;WANG Guangdong;LIU Tingting;JI Wenwen;SHI Zhihong(Departments of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院呼吸与危重症医学科,西安710061

出　　处：《临床误诊误治》2025年第4期11-16,共6页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨肺结节病误诊为肺结核病的原因及防范误诊措施。方法分析2023年5月收治1例被误诊为肺结核病的肺结节病患者临床诊疗经过,结合相关文献分析其误诊原因及防范措施。结果该患者主要症状为间断胸闷、气短,胸部CT提示双侧继发性肺结核病可能,诊断为肺结核病,给予异烟肼+利福平+乙胺丁醇抗结核治疗10个月症状缓解不明显。完善实验室检查、胸部CT、气管镜检查,并取组织、细胞送病理检查,病理检查显示支气管黏膜肉芽肿性炎,最终经多学科诊疗后,考虑诊断肺结节病,误诊时间11个月。确诊后给予口服泼尼松片25 mg,1/d,并逐渐规律减量,共用药10个月。患者定期复诊,自诉症状减轻;复查胸部CT示纵隔增大淋巴结逐渐减小,双肺多发条索影、胸腔积液逐渐好转;复查肺功能好转。现停药2个月,随访中。结论肺结节病患者的症状多不具有特异性,且属于排他性诊断疾病。诊断时应积极进行详尽的病史采集、查体及辅助检查,必要时进行多学科诊疗,以减少误诊。Objective To explore the causes of misdiagnosis of pulmonary sarcoidosis(PS)as pulmonary tuberculosis and preventive measures.Methods The clinical treatment process of a PS patient who was misdiagnosed with pulmonary tuberculosis in May 2023 was analyzed,and the causes of misdiagnosis and preventive measures based on relevant literature were analyzed.Results The main symptoms of the patient were intermittent chest tightness and shortness of breath.Chest CT indicated the possibility of bilateral secondary pulmonary tuberculosis,and the patient was diagnosed with pulmonary tuberculosis.At 10 months after anti-tuberculosis treatment with Isoniazid+Rifampicin+Ethambutol,the symptoms were not alleviated significantly.Laboratory examination,chest CT and tracheoscopy were performed,and tissues and cells were taken for pathological examination,which revealed granulomatous inflammation of bronchial mucosa.Finally,after multidisciplinary diagnosis and treatment,PS was considered for diagnosis,and the duration of misdiagnosis was 11 months.After diagnosis,oral Prednisone tablet(25 mg,1/d)was given,and gradually reduced regularly for 10 months.The patient visited the doctor regularly,and reported that the symptoms were relieved.Reexamination of chest CT showed mediastinal enlargement,gradual reduction of lymph nodes,multiple lung cord shadows,gradual improvement of pleural effusion,and improvement in pulmonary function.The drug has been discontinued for 2 months and is under follow-up.Conclusion Most of the symptoms of PS patients are non-specific and belong to exclusive diagnostic diseases.Detailed history collection,physical examination and auxiliary examination should be actively performed for diagnosis,and multidisciplinary diagnosis and treatment should be carried out when necessary to reduce misdiagnosis.

关 键 词：肺结节病 误诊 肺结核病 肉芽肿 支气管镜 多学科诊疗 糖皮质激素 诊断 

分 类 号：R563[医药卫生—呼吸系统]