恶性胸膜间皮瘤误诊为结核性胸膜炎原因分析

Cause Analysis of Malignant Pleural Mesothelioma Misdiagnosed as Tuberculous Pleurisy

目的分析恶性胸膜间皮瘤(malignant pleural mesothelioma,MPM)的临床特点,以减少误诊。方法对我院收治的1例MPM误诊病例资料进行回顾性分析。结果本例因咳嗽、胸闷、胸痛1个月,加重2周入院。外院胸部CT检查提示左侧胸腔积液,经胸腔积液检查考虑结核性胸膜炎,予诊断性抗结核治疗2周,患者症状逐渐加重,遂转我院。转我院后胸部CT、B超检查均提示左侧大量胸腔积液,血清神经元特异性烯醇化酶48 ng/ml,并结合胸腔镜活检病理及免疫组织化学染色检查确诊为MPM。予培美曲塞二钠联合顺铂化疗,胸腔积液大部分吸收,症状明显好转出院。但11个月后病情恶化死亡。结论临床上对于难以定性的胸腔积液,尤其伴有持续性胸痛者,应高度警惕MPM可能,及早行胸腔镜、CT引导下肺穿刺活检、开胸等检查对确诊有重要意义。

Objective To analyze clinical features and diagnosis of malignant pleural mesothelioma,so as to reduce misdiagnosis rate. Methods Clinical data were retrospectively analyzed from one case of malignant pleural mesothelioma in our hospital,and related literature was reviewed. Results Before admission,the patient complained of cough,chest tightness and chest pain for one month outside the hospital,and chest CT examination showed left pleural effusion,and the patient received anti TB diagnostic therapy for 2 weeks after examination of pleural effusion,but his symptoms gradually deteriorated,and so he was transferred to our hospital. CT ultrasound examination showed left pleural effusions. The serum neuron specific enolase was as high as 48 ng / ml. Biopsy pathology through thoracoscopy and immunohistochemical confirmed of malignant pleural mesothelioma. After chemotherapy of pemetrexed disodium combined with cisplatin,his symptoms were relieved remarkably and he was discharged from hospital,but his condition deteriorated and died 11 months after discharge. Conclusion When pleural effusion is difficult to characterize,especially with chest pain,malignant pleural mesothelioma should be suspected and thoracoscopy and open-chest examination have an important role in definite diagnosis.