气管支气管淀粉样变性临床报告及误诊原因分析

Tracheobronchial Amyloidosis: A Case Report and Misdiagnosed Analysis

目的探讨气管支气管淀粉样变性(tracheobronchial amyloidosis,TBA)的误诊原因及防范措施。方法对1例误诊为支气管哮喘并感染的TBA的临床资料进行回顾性分析。结果患者因咳嗽、咳痰、气喘8个月,加重15 d入院。曾在外院按支气管哮喘并感染给予相应治疗效果不明显。入我院后根据临床表现、胸部CT检查结果及支气管镜黏膜活组织病理检查、刚果红染色阳性诊断为TBA,给予糖皮质激素治疗,症状缓解。出院后90 d电话随访,患者病情稳定,继续糖皮质激素治疗中。结论临床表现缺乏特异性、常规轴位影像学检查易漏诊特征性表现及支气管镜检查受限制是导致TBA误诊的主要原因。

Objective To investigate misdiagnosed causes and prevention methods of tracheobronchial amyloidosis （TBA）. Methods Clinical data of 1 TBA patient misdiagnosed as having bronchial asthma complicated with infection was retrospectively analyzed. Results The patient was admitted for cough, expectoration and shortness of breath for 8 months and deterioration for 15 days. Effect of corresponding treatment for bronchial asthma was poor in other hospital. The patient was confirmed TBA by results of clinical manifestations, chest CT examination, pathological examination of bronchial mucosa biop- sy and positive Congo red staining after admission in our hospital. Glucocorticoid treatment was given, and the symptoms were alleviated. The patient＇s condition was stable by telephone follow-up 90 days after discharge, and glucocorticoid treatment was continued. Conclusion The main causes of misdiagnosis for tracheobronchial amyloidosis include that clinical manifestations are lack of specific, routine axial imaging examination is easily to miss diagnosis and bronchoscopy has limitation.