以咽痛为主诉的误诊病例分析

Misdiagnosed cases with main complaint of pharyngalgia

目的分析以咽痛为主诉误诊病例的原因及鉴别诊断要点。方法回顾分析我科2007年4月～2012年1月收治以咽痛为主诉误诊14例患者的临床资料,其中4例诊断为慢性咽炎,4例诊断为急性上呼吸道感染,6例诊断为扁桃体炎。结果 4例误诊慢性咽炎中,2例为食道癌,2例为亚急性甲状腺炎;4例误诊急性上呼吸道感染中,3例为急性心肌梗死,1例为亚急性甲状腺炎;6例误诊扁桃体炎中,5例为传染性单核细胞增多症,1例为梅毒。结论临床上当咽痛症状明显与体征不相符合时,应考虑到非耳鼻咽喉科疾病,不能轻易诊断为慢性咽炎;耳鼻咽喉科医师加强跨学科知识拓展及多学科的会诊协作,是防止误诊的关键。

Objective To analyze the causes of misdiagnosed cases with the main complaint of pharyngalgia and the key points of differential diagnosis. Methods A retrospective analysis was made in the clinical data of 14 misdiagnosed cases with the main complaint of pharyngalgia in our department from April 2007 to January 2012, in which 4 cases were diagnosed as chronic pharyngitis,4 ones as acute upper respiratory infection,and 6 ones as tonsillitis. Results Among the 4 misdiagnosed cases of chronic pharyngitis, two were esophageal carcinoma, and the other two were subaeute thyroiditis ; among the 4 misdiagnosed cases of acute upper respiratory, three were acute myocardial infarction, and one was subacute thyroiditis; among the 6 misdiagnosed cases of tonsillitis, five were infections mononucleosis, and one was syphilis. Conclusion When the main complaint of serious pharyngalgia doesn＇ t accord with the physical sign, it should be correlated with non - ENT diseases and not be easily diagnosed as chronic pharyngitis. Doctors of the ENT department should learn more interdisciplinary knowledge and strengthen the cooperation of consultation among different departments, which is the key to avoid misdiagnosis.