PET/CT影像诊断为肺癌性淋巴管炎的肺结节病1例报告及文献复习

Pulmonary sarcoidosis diagnosed by PET/CT as pulmonary lymphangitic carcinomatosis:A case report and literature review

目的:探讨肺结节病的临床特点、诊断和治疗方法,提高临床医生对该疾病的认识。方法:收集1例肺结节病患者的临床资料、支气管镜和病理检查结果,并进行相关文献复习。结果:患者因咳嗽、渐进性呼吸困难2个月入院,查体未见明显阳性体征。胸部CT显示双肺多发结节影,双肺门及纵隔淋巴结肿大;PET-CT影像诊断为肺癌伴癌性淋巴管炎(PLC),双侧锁骨上、双肺门及纵隔淋巴结转移。入院后纤维支气管镜病理回报肺组织内见慢性肉芽肿性炎,未见明确坏死,不能完全排除结核。给予患者糖皮质激素和预防性抗结核治疗,1个月后复查胸部CT显示双肺结节明显减少,3个月后患者症状消失,胸部CT显示双肺结节基本消失,肺门和纵隔淋巴结明显缩小,最终诊断为肺结节病。结论:结节病的确诊应主要依据患者的病理诊断并结合临床表现,仅凭临床表现和影像学结果易误诊为肿瘤或者结核。

Objective:To explore the clinical characteristics,diagnosis and treatment methods ofPulomnary sarcoidosis,and to improve the clinicians’understanding ofPulmonary sarcoidosis.Methods:The clinical materials,the results of bronchoscope andPathological examinations of onePulomnary sarcoidosisPatient were collected,and the relative literatures were reviewed.Results:APatient with cough andProgressive dyspnea for 2 months was admitted to the hospital,and thePatient had no obviousPositive signs.The chest CT images showed diffuse nodules in both lungs,bilateral hilar and mediastinal lymph node enlargement;lung cancer withPulmonary lymphangitic carcinomatosis(PLC),and metastasis of bilateral supraclavicular,bilateral hilar,mediastinal lymph nodes were diagnosed byPET-CT images.ThePathological results of fiberoptic bronchoscope after hospitalization showed a chronic granulomatous inflammation in the lung tissue,without obvious necrosis,and tuberculosis could not be entirely excluded.ThePatients were given glucocorticoids andPreventive anti-tuberculosis drugs;1 month later,the chest CT showed a significant reduction in the bilateralPulmonary nodules;3 months later,the symptoms ofPatient disappeared;the chest CT showed the biateralPulmonary nodules basically disappeared,the bilateral hilar and mediastinal lymph nodes were markedly shrunk;thePulmonary sarcoidosis was diagnosed finally.Conclusion:The diagnosis ofPulomnary sarcoidosis should be mainly based on thePathological diagnosis combined with clinical manifestation of thePatient;sarcoidosis is easily misdiagnosed as tumor or tuberculosis only by the clinical manifestations and the imaging results.