变应性支气管肺曲菌病误诊原因及影像特点分析

Misdiagnosis Cause and Imaging Feature of Allergic Bronchopulmonary Aspergillosis

目的探讨变应性肺曲菌病(allergic bronchopulmonary aspergilosis,ABPA)的临床特点及胸部CT表现,减少误诊误治。方法回顾性分析我院明确诊断4例ABPA临床及影像学资料。结果 4例均有不同程度的咳嗽、咳痰,分别误诊为支气管扩张并感染、支气管哮喘、肺结核和肺炎。胸部CT主要表现为中心性支气管扩张和支气管黏液栓形成;实验室检查表现为外周血嗜酸粒细胞增高,血清IgE升高,血清IgE-Af中度敏感,烟曲菌抗原皮内试验呈速发反应阳性,均确诊ABPA。结论在长期喘息、咳嗽的患者中出现中上肺野多发的中心性支气管扩张及支气管腔内黏液栓形成可提示ABPA,确诊需结合血清学检查。

Objective To investigate the clinical features and manifests of chest CT of allergic bronchopulmonary aspergilosis （ABPA） to reduce the misdiagnosis. Methods The clinical and eikonic data of 4 patients with ABPA diagnosed in our hospital were retrospectively analyzed. Results 4 patients had different degrees of cough and expectoration, and they were misdiagnosed as bronchiectasis with infection, bronchial asthma, pulmonary tuberculosis, and pneumonia respectively. Chest CT mainly showed central hronchiectasis and bronchial mucus plug forming. Peripheral blood eosinophils and serum IgE in- creased. Serum IgE-Af showed medium saitivity. Intracutaneous test of aspergillus fumigatus antigen showed quick positive reaction. All the patients were diagnosed as having ABPA. Conclusion The diagnosis of ABPA can be suggested when central bronchiectasis and bronchial mucus plug forming appear in multiple lung fields in the patients with long term of gasping and cough, and combined serological test is necessary in diagnosis.