局灶性机化性肺炎临床特点及误诊分析

Analysis of Clinical Characteristics and Misdiagnosis of Focal Organizing Pneumonia

目的探讨局灶性机化性肺炎(focal organizing pneumonia,FOP)的临床特点、诊断方法和误诊原因,以提高临床医师对本病的认识。方法回顾性分析2010—2016年我院及北京大学第三医院急诊科经病理检查确诊的19例FOP临床资料。结果本组以咳嗽、发热、喘息、咯血及胸痛为主要临床表现。病初根据临床症状及胸部CT检查结果,误诊12例(63.2%),其中8例误诊为肺癌,3例误诊为肺脓肿,1例误诊为真菌感染。病程中19例均行纤维支气管镜检查,无一例活检提示机化性肺炎;8例行正电子发射型计算机断层扫描,其中5例假阳性。最终13例经皮肺穿刺活检确诊,但2例通过外科手术活检分别提示为肺结核及肺腺癌;8例经外科手术活检确诊。结论 FOP临床相对少见,临床表现无特异性,单纯依赖临床症状及胸部CT检查结果极易误诊;临床医师需不断加强对FOP临床特点的认识,熟知其影像学特点,了解各种相关检查方法的优劣性,并排查本病继发病因,以减少临床误漏诊。

Objective To investigate the clinical characteristics, diagnostic methods and misdiagnosis causes of focal organizing pneumonia in order to raise awareness of the disease. Methods The clinical and radiological materials of 19 cases of FOP confirmed by pathology in our hospital and the emergency department of Peking University Third Hospital from 2010 to 2016 were reviewed. Results The symptoms of FOP are non-specific. Cough, fever, wheezing, hemoptysis, and chest pain are the common symptoms. Based on the clinical symptoms and chest CT, 12 （63. 2% ） out of 19 cases were initially misdiag-nosed. Of the 12 cases, 8 were misdiagnosed as malignant disease, 3 were misdiagnosed as pulmonary abscess, and 1 was misdiagnosed as mycotic infection. Bronchoscopy was performed in all 19 cases, but none of the cases was diagnosed with FOP by bronchoscopy biopsy. 5 out of 8 cases showed false positive results in PET/CT. 13 out of 19 cases were diagnosed as organ-izing pneumonia by percutaneous lung puncture, but 2 cases were eventually diagnoses as pulmonary tuberculosis and lung ad-enocarcinoma by surgical lung biopsy, respectively. 8 cases were diagnosed by surgical biopsy. Conclusion FOP is rare in clinic, and the clinical symptoms are non-specific. It is easily misdiagnosed only based on clinical symptoms and chest CT. In order to avoid possible misdiagnosis, clinicians should better understand the characteristics, the imaging features, and the ad-vantages and disadvantages of various tests in the diagnosis of FOP. Meanwhile, clinicians should pay more attention to the ex-amination of secondary etiologies in FOP diagnosis.