先天性肺囊肿囊内出血合并感染1例
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摘要
先天性肺囊肿囊内出血合并感染少见,易误诊。1例14岁男性患儿,因"发热1周,右侧胸痛、痰中带血5 d"入院,外院诊断为"胸腔积液查因",行胸腔闭式引流,引流出血性混浊液体,经抗感染、胸腔冲洗及胸腔镜治疗后仍有发热,并腔内活动性出血,行血管造影及血管栓塞后无效,紧急开胸手术,术后病理证实为先天性肺囊肿并囊内出血合并感染。先天性肺囊肿囊内出血合并感染的影像学特征极易与胸膜腔内出血相混淆,有创操作又增加其影像学鉴别难度,因此临床医生对患者初诊影像资料应高度重视。
Congenital pulmonary cyst is a common benign disease in the lung, but intracapsular hemorrhage combined with infection is rare, which is easy to be misdiagnosed. A 14-year-old male patient presented fever for one week and companied with right chest pain and blood in sputum for 5 days. The external hospital diagnosed the disease as "the cause of pleural effusion" which the patient still had fever and intraluminal active hemorrhage after performing closed drainage of pleural cavity, draining haemorrhagic fl uid, and the treatment of anti-infection, thoracic irrigation, and thoracoscope. Because of no effect after angiography and vascular embolization treatment, emergency thoracotomy was performed. Postoperative pathology proved it to be congenital pulmonary cyst with intracapsular hemorrhage and infection. Intracapsular hemorrhage in congenital pulmonary cyst with infection is easy to be confused with intrapleural hemorrhage in imaging. What's more, invasive operation will increase the difficulty in imaging differentiation. Clinicians should pay a great att ention to the initial images of patients.
Congenital pulmonary cyst is a common benign disease in the lung, but intracapsular hemorrhage combined with infection is rare, which is easy to be misdiagnosed. A 14-year-old male patient presented fever for one week and companied with right chest pain and blood in sputum for 5 days. The external hospital diagnosed the disease as "the cause of pleural effusion" which the patient still had fever and intraluminal active hemorrhage after performing closed drainage of pleural cavity, draining haemorrhagic fl uid, and the treatment of anti-infection, thoracic irrigation, and thoracoscope. Because of no effect after angiography and vascular embolization treatment, emergency thoracotomy was performed. Postoperative pathology proved it to be congenital pulmonary cyst with intracapsular hemorrhage and infection. Intracapsular hemorrhage in congenital pulmonary cyst with infection is easy to be confused with intrapleural hemorrhage in imaging. What's more, invasive operation will increase the difficulty in imaging differentiation. Clinicians should pay a great att ention to the initial images of patients.
引文
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[7]周钱辉,范洁玲,彭红,等.外伤性肺囊肿继发慢性感染误诊为胆固醇性包裹性胸腔积液1例及文献复习[J].中南大学学报(医学版),2017,42(5):591-595.ZHOU Qianhui,FAN Jieling,PENG Hong,et al.Secondary infection of traumatic pulmonary cyst misdiagnosed as cholesterol encapsulated pleural effusion:A rare case and review of literature.Journal of Central South University.Medical Science,2017,42(5):591-595.
[8]St-Georges R,Deslauriers J,Duranceau A,et al.Clinical spectrum of bronchogenic cysts of the mediastinum and lung in the adult[J].Ann Thorac Surg,1991,52(1):6-13.
[9]Casagrande A,Pederiva F.Association between congenital lung malformations and lung tumors in children and adults.A systematic review[J].J Thorac Oncol,2016,11(11):1837.
[10]Priest JR,Williams GM,Hill DA,et al.Pulmonary cysts in early childhood and the risk of malignancy[J].Pediatr Pulmonol,2009,44(1):14-30.
[2]Haddon MJ,Bowen A.Bronchopulmonary and neurenteric forms of foregut anomalies.Imaging for diagnosis and management[J].Radiol Clin North Am,1991,29(2):241.
[3]伍定平,邓开鸿,周翔平.肺囊肿CT表现类型及其病理基础[J].临床放射学杂志,2002,21(6):429-431.W U D i n g p i n g,D E N G K a i h o n g,Z H O U X i a n g p i n g.CTmanifestations of bronchogenic cysts:Classification and pathologic correlation[J].Journal of Clinical Radiology,2002,21(6):429-431.
[4]赵泽钢,谢汝明,周新华.不典型支气管肺囊肿的影像学表现[J].中国医学影像技术,2005,21(2):295-297.ZHAO Zegang,XIE Ruming,ZHOU Xinhua.Atypical imaging manifestation of bronchogenic cysts[J].Chinese Journal of Medical Imaging Technology,2005,21(2):295-297.
[5]李炘,陈张根,贾兵,等.先天性肺囊性病的诊断和手术治疗[J].复旦学报(医学版),2007,34(3):455-458.LI Xin,CHEN Zhanggen,JIA Bing,et al.Congenital cystic lung lesions:diagnosis and surgical management[J].Fudan University Journal of Medical Sciences,2007,34(3):455-458.
[6]袁五营,汤少鹏,李遂莹.先天性支气管肺囊肿误诊68例分析[J].中国误诊学杂志,2007,7(1):76.YUAN Wuying,TANG Shaopeng,LI Suiying.Misdiagnosis of congenital bronchopulmonary cyst:an analysis of 68 cases[J].Chinese Journal of Misdiagnostics,2007,7(1):76.
[7]周钱辉,范洁玲,彭红,等.外伤性肺囊肿继发慢性感染误诊为胆固醇性包裹性胸腔积液1例及文献复习[J].中南大学学报(医学版),2017,42(5):591-595.ZHOU Qianhui,FAN Jieling,PENG Hong,et al.Secondary infection of traumatic pulmonary cyst misdiagnosed as cholesterol encapsulated pleural effusion:A rare case and review of literature.Journal of Central South University.Medical Science,2017,42(5):591-595.
[8]St-Georges R,Deslauriers J,Duranceau A,et al.Clinical spectrum of bronchogenic cysts of the mediastinum and lung in the adult[J].Ann Thorac Surg,1991,52(1):6-13.
[9]Casagrande A,Pederiva F.Association between congenital lung malformations and lung tumors in children and adults.A systematic review[J].J Thorac Oncol,2016,11(11):1837.
[10]Priest JR,Williams GM,Hill DA,et al.Pulmonary cysts in early childhood and the risk of malignancy[J].Pediatr Pulmonol,2009,44(1):14-30.