摘要
目的总结气管支气管淀粉样变的临床表现、影像表现、鉴别诊断及治疗方法。方法报道就诊于山东大学附属省立医院经支气管镜活检病理确诊为气管支气管淀粉样变的3例病例,复习相关文献。结果气管支气管淀粉样变临床症状及影像学无特异性,临床症状主要为:咳嗽、胸闷、憋气、呼吸困难、咯血等,影像学上可出现管壁钙化或增厚,管腔狭窄,增强扫描可见病灶有强化,其中管壁钙化为较特异性的特征,临床误诊及漏诊常见,局限的气管支气管淀粉样变容易漏诊,病变较弥漫的可伴有肺门淋巴结肿大及钙化、肺部结节状或斑片状高密度影,容易误诊为支气管哮喘、肺结核、慢性支气管炎等疾病。结论气管支气管淀粉样变临床少见,症状无特异性,由临床医师对影像学观察及认识不足导致误诊漏诊常见。提高对本病的认识,对其影像学表现及临床特征综合分析,并及时行支气管镜检查,病理学显示淀粉样物质沉积,刚果红染色阳性可明确诊断,有助于减少误诊。
Objective To explore the clinical and imaging manifestations,differential diagnosis and treatment of tracheobronchial amyloidosis. Methods The clinical data of 3 cases of tracheobronchial amyloidosis were retrospectively analyzed,and relevant literature was reviewed. Results Tracheobronchial amyloidosis exhibited no specific clinical or imaging manifestations. The main clinical symptoms included cough,chest distress,dyspnea,hemoptysis,and so on.The imaging manifestations included calcification( which was specific),thickening of wall,and narrowing of the lumen. In enhanced scanning,strengthened lesions could be observed. Clinical misdiagnosis and missed diagnosis often occurred due to localized tracheobronchial amyloidosis. Diffused lesions with hilar lymph node enlargement,calcification,and pulmonary nodular or patchy high-density shadowwere often misdiagnosed as bronchial asthma,tuberculosis,chronic bronchitis and other diseases. Conclusion Tracheobronchial amyloidosis is a rare disease with no specific symptoms. Misdiagnosis and missed diagnosis frequently occur due to insufficient clinical and imaging understanding of the disease. Comprehensive analysis of the imaging manifestations and clinical characteristics,together with bronchoscopy and pathological examination,can help avoid possible misdiagnosis.
作者
庄麦松
万云焱
林殿杰
ZHUANG Maisong;WAN Yunyan;LIN Dianjie(Department of Respiratory Medicine,Shandong Provincial Hospital Affiliated to Shandong University,Jinan 250021,Shandong,China;First Department of Internal Medicine,Leling People's Hospital,Leling 253600,Shandong,China)
出处
《山东大学学报（医学版）》
CAS
北大核心
2018年第12期39-46,共8页
Journal of Shandong University:Health Sciences
关键词
气管支气管
淀粉样变
误诊
Tracheal bronchus
Amyloidosis
Misdiagnosis
