摘要
目的分析不典型肺结核的影像学表现及其误诊原因。方法回顾性分析2018年8月—2020年6月收治确诊70例肺结核中曾误诊的11例不典型肺结核的临床资料。结果本组误诊率为15.71%。误诊11例中6例因咳嗽、咳痰、胸痛入院且年龄均>50岁,4例因发热、咳嗽等就诊,1例在体检中发现肺部结节就诊;误诊为肺癌6例,肺炎3例,侵袭性肺真菌感染、肺结节病各1例,误诊时间3~33 d。11例进一步完善动态CT增强扫描及痰液结核菌检查等确诊为不典型肺结核。明确诊断后11例均按标准治疗方案给予异烟肼、利福平、吡嗪酰胺、链霉素、乙胺丁醇行三联(5例)或四联(6例)抗结核治疗,均治愈。结论不典型肺结核缺乏特异性临床症状,易出现误诊,提高临床医生对该病的认知,结合临床全面考虑,综合判断,正确运用针对性检查手段,有望降低误诊率,提高临床诊治水平。
Objective To analyze imaging manifestations and misdiagnosed reasons of atypical tuberculosis.Methods Clinical data of 11 patients with atypical tuberculosis who were misdiagnosed among 70 patients diagnosed as having tuberculosis admitted during August 2018 and June 2020 was retrospectively analyzed.Results The misdiagnosed rate was 15.71%.Among the 11 misdiagnosed patients,6 patients were admitted for cough,expectoration and chest pain,and they were all aged over 50 years old;4 patients visited for fever and cough,and 1 patient visited for pulmonary nodule by physical examination.Of them,there were 6 patients misdiagnosed as having lung cancer,3 patients as having pneumonia,1 as having invasive lung fungal infection and 1 as having pulmonary nodule,and misdiagnosed duration was from 3 to 33 d.All the 11 patients were confirmed as having atypical tuberculosis by further dynamic enhanced CT scan and sputum examination for tubercle bacillus.After confirmation,11 patients were treated with anti-tuberculosis treatments of Isoniazid,Rifampicin,Pyrazinamide,Streptomycin,Ethambutol for triple(n=5)or quadruple(n=6)according to the standard treatment plan,and they all cured.Conclusion Atypical pulmonary tuberculosis is prone to misdiagnosis due to the lack of specific clinical symptoms.Clinicians should improve their understanding of the disease,make comprehensive consideration by combining clinical results,make comprehensive judgments and correctly perform targeted examinations in order to reduce misdiagnosed rate and improve clinical diagnosis and treatment.
作者
郭建昌
王玮娜
GUO Jian-chang;WANG Wei-na(Department of Radiology,People's Hospital of Handan City,Handan,Hebei 056000,China;Department of CT,the Third Hospital of Shijiazhuang City,Shijiazhuang 050000,China)
出处
《临床误诊误治》
CAS
2021年第6期1-4,共4页
Clinical Misdiagnosis & Mistherapy
基金
河北省医学科学研究重点课题计划项目(20181047)。
关键词
不典型肺结核
体层摄影术
螺旋计算机
误诊
肺肿瘤
肺炎
结节病
肺
Atypical pulmonary tuberculosis
Tomography,spiral computed
Misdiagnosis
Lung neoplasms
Pneumonia
Sarcoidosis,pulmonary
