老年慢性阻塞性肺疾病合并肺结核漏诊报告并文献复习

Missed Diagnosis and Literature Review of Elderly COPD Patient with Pulmonary Tuberculosis

目的探讨老年慢性阻塞性肺疾病(chronic obstructive pulmonary diseases,COPD)合并肺结核的临床表现、影像学特点及漏诊原因、防范措施。方法回顾性分析曾漏诊肺结核的老年COPD合并肺结核1例的临床资料并复习相关文献。结果 68岁男性患者因反复发热2月余,咳黄黏痰1周入院。有COPD病史5年。7.7个月及2个月前分别因胸痛和腹痛入住我院,经胸部CT等检查诊断为COPD,给予抗感染等治疗病情可好转。此次入院结合临床及影像学表现、2次痰查抗酸染色均阳性,诊断COPD合并肺结核,给予抗结核治疗后病情好转。结论老年COPD合并肺结核临床并不少见,但因临床表现缺乏特异性及特征性影像学演变过程出现较慢,易漏误诊;临床医师应熟悉其病情特点,遇及疑似患者要反复送痰检及动态监测肺部影像学变化,以提高该病临床诊断率。

Objective To investigate clinical manifestations, imaging features, missed diagnosis causes and prevention measures of elderly chronic obstructive puhnonary diseases （COPD） patients with pulmonary tuberculosis. Methods Clinical data of an elderly COPD patient with pulmonary tuberculosis, who was missed diagnosis of pulmonary tuberculosis, was retrospectively analyzed, and related literature was reviewed. Results A 68 years old male patient was admitted for repeated fever for more than 2 months and yellow phlegm for 1 week with five years history of COPD. He had admitted for thoracalgia and celialgia respectively 7.7 months and 2months before this time of admission in our hospital, and had diagnosed as having COPD by chest CT, and his condition had gotten better after anti-infection treatment. COPD combined with pulmonary tuberculosis was confirmed by results of clinical manifestations, imaging features and positive acid fast stain test of sputum smear this time, and then the patient＇s condition got better after anti- tuberculosis treatment. Conclusion The elderly COPD patients with pulmonary tuberculosis is common in clinical practice, but it is easily missed diagnosis or misdiagnosed because the clinical manifestations are lack of specificity, and the evolution of imaging features is slow. Clinicians should pay much attention to the disease features and perform repeatedly acid fast stain test of sputum smear and dynamic detection of pulmonary imaging characteristic changes for suspected patients to improve diagnosis rate.