摘要
目的提高对以胸腔积液为首发表现的胸膜肺结节病(PPS)的认识,减少临床误诊及漏诊率.方法回顾1例以胸腔积液为首发表现的PPS,并结合国内外文献对该病例特殊性分析.结果该病例为中年女性,以咳嗽、活动后气促为主要临床症状,因查胸片提示胸腔积液,以"胸腔积液性质待查"收住入院.入院后行胸腔闭式引流、胸部CT、PET/CT等无法明确,后行锁骨上淋巴结活检示增生性肉芽肿性病变,结合影像学、淋巴结活检病理明确诊断,给予激素治疗后症状、影像学好转.结论PPS以胸腔积液为首发相对少见,临床症状无特异性,胸腔积液理化性质无特异性,病理、生理基础为肺实质、胸膜非干酪肉芽肿浸润,确诊需要依赖胸膜、肺(支气管)组织活检.但对于一些无法开展内科胸腔镜或纤维支气管镜活检的医院,行浅表肿大淋巴结活检亦是一种可行的诊断方法和手段,同时PET/CT在PPS诊断中亦有重要的作用.
Objective To improve the recognition of pleuropulmonary sarcoidosis(PPS)with pleural effusion as the first manifestation and reduce the rate of misdiagnosis and missed diagnosis.Methods A case of PPS with pleural effusion as the first manifestation was retrospectively reviewed.The particularity of this case was analyzed in combination with domestic and foreign literatures.Results The patient was a middle-aged woman while cough and shortness of breath after exercise was her main clinical symptoms.Chest radiographs revealed pleural effusion.The patient was admitted to hospital with diagnosis of"the nature of pleural effusion to be examined".After admission,the patient received closed thoracic drainage,chest computed tomography(CT),positron emission tomography(PET)/CT,but the diagnosis was still not clear.Subclavian lymph node biopsy showed proliferative granulomatous lesions.Combined with imaging and lymph node biopsy,the diagnosis was confirmed.Symptoms and imaging improved after hormone therapy.Conclusions PPS with pleural effusion as the first manifestation is relatively rare.It has nonspecific clinical symptoms,no characteristic physical and chemical properties of pleural effusion.The pathological and physiological basis of PPS is lung parenchyma,pleural non-caseous granuloma infiltration.The diagnosis needs to rely on pleural and pulmonary(bronchial)tissue biopsy.But for some hospitals unable to carry out medical thoracoscopy or fiberoptic bronchoscopy biopsy,superficial enlarged lymph node biopsy is also a feasible diagnostic method,and PET/CT plays an important role in the diagnosis of PPS.
作者
丁强
唐亮
壮健
王月娇
梁国平
Ding Qiang;Tang Liang;Zhuang Jian;Wang Yuejiao;Liang Guoping(Department of Respiratory Medicine,Wuxi Hospital affiliated to Nanjing University of Chinese Medicine,Wuxi 214071,China;Graduate School,Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China)
出处
《国际呼吸杂志》
2019年第21期1621-1625,共5页
International Journal of Respiration
基金
无锡市“科教强卫工程”青年医学人才项目(QNRC099)。
