巨型肺大泡并气胸二例误诊分析

Misdiagnosis Analysis of Two Cases of Giant Bullae-associated Pneumothorax

目的分析巨型肺大泡伴气胸形成的临床特点及误诊原因,旨在提高对该类疾病的认识。方法对巨型肺大泡伴气胸形成2例的临床资料进行回顾性分析,并复习相关文献。结果本文2例均因气短并呼吸困难在当地医院就诊,经X线胸片诊断为气胸,行胸腔闭式引流术,症状未见好转。入我科后经CT检查2例均确诊为单侧巨型肺大泡伴气胸形成,行肺大泡切除术及胸膜固定术后恢复良好,痊愈出院。结论接诊X线提示肺部大面积透亮区并呼吸困难者要考虑到肺大泡可能,严禁穿刺,应及时行影像学随访并进一步行CT检查,尽早明确诊断并积极手术治疗。

Objective To analyze clinical features and causes of misdiagnosis of bullae-associated pneumothorax in order to raise awareness regarding bullae-associated pneumothorax through two cases and the corresponding review of literature.Methods The clinical data of two bullae-associated pneumothorax was retrospectively analyzed and the relevant literature was reviewed. Results Both the patients were misdiagnosed as having pneumothorax with the symptom of shortness of breath,and closed drainage of pleural cavity was performed. After the surgery,the patients did not show clinical improvement. The patients were transferred to our department and underwent CT examination,which confirmed the diagnosis of giant bullae. The patients were cured after undergoing gain bulla removal operation and pleurodesis. Conclusion The patients with shortness of breath and large radiolucent area by X-ray should be suspected as having pulmonary bullae. Puncture must not be done. The patients should be followed up by chest computed tomography and further imaging examinations. As soon as the disease is confirmed,an exploratory thoracotomy should be performed.