非典型结节病21例临床分析

Atypical intrathoracic sarcoidosis: a report of 21 cases

目的 提高对非典型结节病的认识。方法 回顾性分析了２１ 例非典型结节病的临床资料，所有病例均经病理检查证实。结果 不典型结节病影像学可表现为：（１）肺内病变：有孤立结节影，肺不张，单侧、双侧肺实变，双肺栗粒样结节。（２） 单纯纵隔淋巴结病变：有纵隔肿物，纵隔淋巴结肿大和单侧肺门淋巴结肿大，纵隔单纯淋巴结肿大。（３） 胸膜病变：有液、气胸，胸膜增厚。（４） 肺门病变：有单侧肺门淋巴结肿大和纵隔淋巴结肿大，双侧肺门淋巴结非对称性肿大， 单侧肺门淋巴结肿大钙化。结论 不典型结节病临床表现多种多样，影像学检查难以满足诊断需要。只有对结节病有足够认识，辅以其他检查，其诊断并不困难。

Objective To improve the recognition of atypical intrathoracic sarcoidosis. Methods The clinical data of 21 cases with atypical intrathoracic sarcoidosis were analyzed retrospectively. All the cases had pathological examination data. Results The manifestations of atypical intrathoracic sarcoidosis might be as follows: intrapulmonary pathological changes including solitary nodular shadow, atelectasis, unilateral lung consolidation, bilateral lung consolidation and bilateral pulmonary miliary nodes; simple mediastinal lymph node lesion including mediastinal tumor, mediastinal lymph node enlargement plus unilateral pulmonary hilar lymph node enlargement and simple mediastinal lymph node enlargement; pleural lesion including hydropneumothorax and pleural thickening; pulmonary hilar lesion including unilateral pulmonary hilar lymph node enlargement plus mediastinal lymph node enlargement and bilateral pulmonary hilar lymph node enlargement and calcification. Conclusion The clinical manifestations of atypical intrathoracic sarcoidosis are variable. The establishment of the diagnosis cannot be based on image examination alone. With sufficient knowledge of the clinical manifestations of sarcoidsis and other testing methods, the diagnosis can be made correctly.