摘要
目的探讨肺隔离症(pulmonary sequestration,PS)的发病机制、诊治方法及误诊原因,以减少误诊误治。方法对1例叶内型PS误诊患者资料进行回顾性分析,并复习相关文献。结果本例为67岁女性,因反复咯血15年,加重3 d入院。曾在外院诊断为支气管扩张症,给予常规抗感染、止血等处理,咯血症状反复发作。我院CT检查提示右下肺占位性病变,提示肺腺癌可能,考虑咯血可能由肺腺癌导致。上级医师查房提示,患者纤维支气管镜、肿瘤标志物结果及与既往影像学资料对比均不支持恶性肿瘤诊断,需考虑支气管或肺血管畸形可能。后经CT肺动脉造影检查确诊为叶内型PS,转心胸外科行肺叶切除术,术后随访1年,未见复发。结论 PS临床表现缺乏特异性,误诊率较高;对X线胸片、CT及气管镜等常规检查均不能明确病因的咯血患者,应考虑本病可能,螺旋CT动脉造影及数字减影血管造影等检查有助于诊断。
Objective To explore the pathogeny, diagnosis, treatment and misdiagnosed reasons of Pulmonary Sequestration （PS） , and to reduce the chance of misdiagnosis and mistreatment. Methods Clinical data of a patient with in-tralobar pulmonary sequestration was retrospectively analyzed and related literature were also reviewed. Results This 67-year- old female was admitted to our hospital with a chief complaint of a recurrent hemoptysis for 15 years, worsened for 3 days. She was diagnosed as bronchiectasia in other hospitals and treated with anti-biotics, Hemostatics, etc. , which had little effect. At the beginning, we had thought about the diagnosis of lung adenocarcinoma based on the chest CT image where a space-occup-ying leision of right lower lobe was shown. However, our senior physician considered low probability of malignant tumor when we compared the CT image with that years ago. This diagnosis was also unsupported by bronchoscopy and tumor makers test results. Considering the chance of bronchopulmonary malformations, we performed a CTPA on the patient and it identified the mass lesion as intralobar pulmonary sequestration. The patient was later transferred to department of thoracic surgery and trea-ted with lobectomy. After a one-year follow-up observation, no complications and related symptoms occurred. Conclusion Symptoms of PS are often nonspecific, which may lead to a high rate of misdiagnosis. As physicians, we are supposed to think of the probability of PS when routine tests like X-rays, CT or bronchoscopy fail to identify the cause of hemoptysis. CTA and DSA are essential for diagnosis of PS.
出处
《临床误诊误治》
2018年第1期25-29,共5页
Clinical Misdiagnosis & Mistherapy
关键词
支气管肺隔离症
咯血
误诊
支气管扩张症
Bronchopulmonary sequestration
Hemoptysis
Misdiagnosis
Bronchiectasis
