肺上沟瘤的临床误诊分析及影像诊断

Clinic misdiagnosis and imaging analysis of superior sulcus tumors of pulmonary

目的：分析肺上沟瘤的误诊原因及影像学表现，提高临床医生对本病的认识。方法回顾性分析19例经病理证实的肺上沟瘤患者的临床表现、影像学表现及误诊情况。结果19例肺上沟瘤患者中，病史2．6～9．7个月不等，19例中17例有肩背部疼痛，15例有颈部疼痛，14例有前臂疼痛，11例有手放射性疼痛，6例患者出现霍纳综合征；疼痛程度（VAS法）4～7分不等。19例中16例曾误诊，其中误诊为肩周炎9例，颈椎病4例，颈肩综合症3例。有5例常规X线胸片检查未见明显异常，摄前弓位片显示肺尖软组织密度影。C T均显示一侧肺尖部软组织密度增高影，其中有17例患者肿瘤累及到肋骨，15例患者累及到T 1或T 2椎体，11例患者锁骨下动脉受累，13例患者锁骨下静脉受累，10例患者肿瘤同时累及到T1和第一肋骨，7例患者锁骨下动脉及锁骨下静脉同时受累。结论肩背部疼痛是肺上沟瘤最常见的首发症状，肺上沟瘤容易误诊，发现时多为中晚期，前弓位X线胸片及多层螺旋CT （应用多平面重建技术）对肺上沟瘤的诊断有很大的价值，对临床诊断及治疗具有重要意义。

Objective To analyze misdiagnosis reason and imaging characteristics of superior sulcus tumors of pulmonary so as to improve the diagnostic accuracy .Methods The clinical symptoms ,imaging findings and misdiagnosis reasons of 19 cases of superior sulcus tumors of pulmonary were investigated retrospectively .Results In the 19 patients with superi‐or sulcus tumors of pulmonary ,medical history were about 2 .6~9 .7 months .The earliest clinical symptoms included pain in shoulder and back （n=17 cases） ,neck pain （n=15 cases） ,upper extremity pain （n=14 cases） ,hand radiated pain （n=11 cases） ,and Horner’ syndrome （n=6 cases） .According to VAS method ,the pain degrees were 4~7 scores .16 out of the 19 cases were misdiagnosed ：9 patients were diagnosed as periarthritis of shoulder ,4 as cervical spondylosis and 3 as neck‐shoulder syndrome .Routinely ,chest X‐ray film was negative in 5 cases .But anterior arch radiography showed soft tissue density in lung apex .CT imaging showed soft tissue density shadows at the apical segments of the lungs in all cases . Tumors invaded the ribs in 17 patients and the T1 or T2 vertebral bodies in 15 patients .11 subclavian arteries and 13 sub‐clavian veins were encased by the tumors .10 patients suffered from tumors invading T 1 vertebral body and the first ribs .7 tumors encased the subclavian artery and the subclavian vein simultaneously .Conclusion Painful shoulder and back were the common initial symptoms of superior sulcus tumors of pulmonary ,which is often identified in intermediate and ad‐vanced stage and misdiagnosed .Anterior arch radiography and multi‐slice CT with excellent post‐processing techniques may play an important role in the clinical diagnosis and therapy of superior sulcus tumors of pulmonary .