15例儿童支气管结核误诊的临床分析

Clinical analysis of 15 cases of bronchial tuberculosis in misdiagnosed children

目的:通过对误诊的儿童支气管结核临床特征以及支气管镜下表现进行分析,以提高对该病的认识。方法:对误诊的15例儿童支气管结核的临床症状、胸部影像学表现、支气管结核的发病部位及镜下表现进行回顾性分析。结果:15例儿童支气管结核主要症状为慢性咳嗽、胸闷,易被误诊为哮喘、慢性支气管炎,误诊的中位时间是3个月;CT多表现为肺部大片状高密度影或斑片影或肺不张;支气管镜下表现以溃疡坏死型和炎症浸润型为主;好发于上叶、下叶基底段及背段支气管。结论:儿童支气管结核的临床症状及影像学表现缺乏特异性。对长期慢性咳嗽、胸闷,抗感染及平喘治疗后症状仍反复、胸部CT表现为大片状影的患儿,需要提高警惕,怀疑是否有支气管结核可能,尽早行气管镜检查以明确诊断。

Objective： To improve the understanding of bronchial tuberculosis in children in order to reduce misdiagnosis. M ethods： The clinical symptoms, chest imaging findings, site of disease and microscopic manifestations of 15 children with bronchial tuberculosis misdiagnosed were analyzed retrospectively,on top of which,we shared a typical case. Results： The median time of misdiagnosis in 15 children with endobronchial tuberculosis was 3 months. The main manifestations were chronic cough and expectoration, so they were misdiagnosed as asthma and chronic bronchitis. The types of bronchial tuberculosis were mainly ulcerative necrosis and inflammatory infiltration; their sites were often found in the upper and lower lobes. Conclusion： The clinical symptoms and imaging findings of endobronchial tuberculosis in children lack of specificity,so they are easily misdiagnosed. In clinical diagnosis and treatment,attention should be paid to the disease. Bronchoscopy should be done as early as possible to make a definite diagnosis.