肺曲霉病12例临床分析

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目的探讨侵袭性肺曲霉病的临床表现和影像学特点。方法回顾性调查研究汕头大学医学院第一附属医院自1998年1月至2007年12月确诊的12例侵袭性肺曲霉病。结果肺曲霉病的症状主要表现为咳嗽10例(83.3%),咳白黏痰5例(41.7%),咯脓痰4例(33.3%),咯血痰3例(25.0%),咯血2例(16.7%),咯血量10~50ml/次,发热6例(50.0%),胸闷3例(25.0%),胸痛3例(25.0%),消瘦4例(33.3%),盗汗3例(25.0%),喘息1例(8.3%)。影像学主要表现为:3例(25.0%)发现空洞内球状软组织影,球形内容物与洞壁存有新月形或环形透亮影,4例(33.3%)浸润性团块阴影;2例(16.7%)表现为肺内孤立圆形结节状影;2例(16.7%)表现为肿块样软组织密度影;1例(8.3%)表现为两肺弥漫性斑片状实变影。确诊方法:12例均临床确诊。其中外科手术后病理报告8例(66.7%),纤维支气管镜下活检2例(16.7%),纤维支气管镜无菌毛刷刷检找到曲霉菌菌丝及孢子1例(8.3%),经纤维支气管镜抽吸病灶部位分泌物或以灌洗液做霉菌培养获阳性结果1例(8.3%)。12例肺曲霉病,其中7例误诊,误诊率达58.3%,多误诊为肺结核、肺癌。结论肺曲霉病的症状及影像学改变不典型,误诊率高,病理组织活检具有重要的诊断价值。 Objective To investigate the clinical manifestations and imaging features of invasive pulmonary aspergillosis. Methods Retrospective investigation of 12 cases of invasive pulmonary aspergillosis diagnosed in the First Affiliated Hospital of Shantou University Medical College from January 1998 to December 2007 was performed. Results The symptoms of pulmonary aspergillosis were mainly cough in 10 cases (83.3%), cough white sticky sputum in 5 cases (41.7%), purulent sputum in 4 cases (33.3%), hemoptysis sputum in 3 cases (25.0%) and hemoptysis in 2 cases (25.0%), chest pain in 3 cases (25.0%), weight loss in 4 cases (33.3%), night sweats in 3 cases (25.0%), chest tightness in 3 cases %), Wheezing in 1 case (8.3%). Imaging findings were mainly as follows: 3 cases (25.0%) found intracavity spherical soft tissue, spherical contents and cave wall with crescent or ring translucent shadow, 4 cases (33.3%) infiltrative mass shadow; 2 cases ( 16.7%) showed isolated round nodules in the lungs. Two cases (16.7%) showed mass-like soft tissue densities and one case (8.3%) showed diffuse patchy densities in both lungs. Diagnosis method: 12 cases were clinically diagnosed. Among them, 8 cases (66.7%) were pathologically reported after surgery, 2 cases (16.7%) were biopsied by fiberoptic bronchoscopy, and 1 case (8.3%) of aspergillus hyphae and spores were detected by fiberoptic bronchoscopy. Bronchoscopy was used to aspirate the secretions from the lesion site or to mold cultures with lavage fluid in 1 patient (8.3%). 12 cases of pulmonary aspergillosis, of which 7 cases misdiagnosis, misdiagnosis rate of 58.3%, misdiagnosed as tuberculosis, lung cancer. Conclusion The symptoms and imaging changes of pulmonary aspergillosis are not typical, the rate of misdiagnosis is high, and biopsy of pathological tissue has important diagnostic value.
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