空洞型肺癌误诊为肺曲霉菌病的原因分析

The reason for cavitating lung adenocarcinoma misdiagnosed as pulmonary aspergillus disease

目的通过分析1例以肺内单发空洞为表现的周围型肺癌误诊原因,总结经验教训以降低误诊率。方法回顾分析1例空洞型肺癌误诊为肺曲霉菌病的临床资料,并复习相关文献。结果本例患者为44岁男性,以咳嗽、咯血症状起病,CT发现右下肺单发空洞,被误诊为肺曲霉菌病7个月,经抗真菌治疗后临床症状好转,多次复查胸部CT提示肺内空洞大小未见明显变化,洞壁变厚,原发空洞内结节消失并新发微小附壁结节,空洞边缘出现锯齿状突起,周围出现多发卫星结节,胸膜牵拉、相连渐进明显。后经CT引导下肺穿刺活检确诊为右肺下叶中-低分化腺癌。结论肺内单发空洞的鉴别诊断有一定难度,需要通过影像学结合临床特征和实验室检查来仔细鉴别,PET/CT可以很好的对其良恶性进行鉴别,组织病理是确诊的金标准,为避免误诊误治,在没有明确禁忌和高危因素的情况下,及早活检是十分必要的。

Objective To conclude the experience and reduce misdiagnosis rate in future by analyzing a case of single lung cancer cavity misdiagnosed as pulmonary aspergillosis cavity on CT.Methods A patient with lung cancer cavity misdiagnosed as pulmonary aspergillosis was retrospectively analyzed and relevant literatures were reviewed.Results Onset with cough and hemoptysis,a 44-year-old male patient was found with a solitary cavity in the lower lobe of right lung,was misdiagnosed as pulmonary aspergillosis for seven months.The clinical symptoms were improved after antifungal treatment,but there was no obvious change on pulmonary cavity by many times chest CT reexamine.The cavity wall became thicker,the nodules within primary cavity disappeared,and many new tiny wall nodules were found.Serrated protrusions and multiple satellite nodules appeared on the cavity margin and around the cavity respectively.The stretch and connection between cavity and pleura became obvious gradually.Then a definite diagnosis of moderately and poor differentiated lung adenocarcinoma in the lower lobe of right was produced through lung puncture biopsy guided by CT.Conclusion There had certain diffculty to make differential diagnosis of solitary lung cavity by radiographic methods.Clinical characteristics and laboratory tests should be combined to help identification.Tissue pathology was the gold standard for diagnosis.So early biopsy might benecessary to avoid the misdiagnosis and mistreatment,provided that there was no obvious tabooes and risk factors.