肺隔离症误诊为肺脓肿一例并文献复习

One Case of Pulmonary Sequestration Misdiagnosed as Pulmonary Abscess: a Case Report and Literature Review

目的加强对肺隔离症(pulmonary sequestration,PS)临床特点及诊疗手段的认识,减少临床误漏诊。方法回顾性分析PS误诊肺脓肿1例的临床资料,并结合文献进行复习。结果本例男,43岁,因咳嗽、咳痰伴发热就诊,门诊胸部CT平扫示左下肺空洞伴液平面,以肺脓肿收入院予抗感染治疗有效,继续治疗1个月后,因肺部病变未吸收,行胸部CT增强扫描示胸主动脉下段有一分支进入左下肺基底段病灶内,修正诊断为PS,转外科择期手术治疗,术后病理证实诊断。结论 PS临床表现无特异性,极易误漏诊,对于肺部感染反复发生或经抗感染治疗后病灶不吸收,尤其是年轻、病灶位于左下肺者,应警惕PS可能,胸部CT增强扫描等检查有助于确诊。

Objective To improve the correct diagnosis of pulmonary sequestration（ PS） in order to reduce misdiagnosis and missed diagnosis rates. Methods Clinical date of one case of pulmonary sequestration misdiagnosed as pulmonary abscess was retrospectively analyzed and relevant references about pulmonary sequestration were reviewed. Results The 43-years old male patient was admitted for cough,expectoration and fever. CT scanning showed a hollow hole in the lower left lung with liquid and the patient responded to anti-infection therapy for lung abscess. A month later,CT scanning showed a branch of pulmonary artery entered lower left lung and the abscess was not absorbed due to pathological changes in the lungs.A revised diagnosis was PS,which was confirmed by postoperative pathological test. Conclusion Because of the non-specific clinical manifestations of pulmonary sequestration,the disease tends to easily misdiagnosed or missed diagnosed especially for those who has repeated lung infection and whose lesion will not be absorbed after anti- infection therapy and PS should be considered in young patients whose lesion is in the left lower lung. The best inspection method is enhanced CT scan,which can clearly show the lesions characteristic of pulmonary sequestration.