以胸腔积液起病的急性髓细胞白血病误诊原因分析

Misdiagnosis Causes of Acute Myelogenous Leukemia with the Onset of Pleural Effusion

目的探讨急性髓细胞白血病(acute myelogenous leukemia,AML)的发病特点,提高对本病的认识。方法对1例以胸腔积液起病的AML患者的临床资料进行回顾分析并复习相关文献。结果患者因咳嗽、喘息伴左颈部肿痛入院,病初在外院行X线胸片检查发现胸腔积液,行CT检查见颈部及纵隔淋巴结增大,先后按肺部感染、结核性胸膜炎治疗无效,病程1个月左右双侧颈部迅速肿大、呼吸困难,多专科会诊,最终经骨髓穿刺细胞学检查及免疫组织化学染色检查确诊为AML。结论 AML浸润胸膜时可能以大量胸腔积液起病,浸润淋巴结可表现淋巴结增大,对此类病人要考虑到白血病的可能,避免误诊。

Objective To explore pathogenetic characteristics of acute myelogenous leukemia （AML） in order to improve the awareness of the disease.Methods Clinical data of one AML patient with the onset of pleural effusion was retrospectively analyzed,and related literature was also reviewed.Results The patient was admitted for coughing and gasping with sore pain in the left neck.The pleural effusion was found by X-ray chest radiography examination,neck and mediastinal lymph nodes enlargement were found by CT examination at the onset of the disease in other hospitals,and corresponding treatments of pulmonary infection and tuberculous pleurisy were reported ineffective.Bilateral necks rapidly became enlarged with breathing difficulty after about 1 month of the course,and AML was diagnosed by specialists consultation,bone marrow aspiration of cytological examination and immunohistochemical staining test.Conclusion The onset of AML may begin with pleural effusion for pleural infiltration,and infiltrating lymph nodes may turn to be enlarged lymph nodes,so clinicians should consider the possibility of leukemia in these patients.