肺韦格肉芽肿误诊为肺脓肿1例报道
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摘要
目的探讨1例肺韦格肉芽肿的临床表现及误诊原因,提高该病的诊治水平。方法对1例以肺部空洞为主要表现的肺韦格肉芽肿患者的临床资料进行回顾性分析并复习相关文献。结果患者因咳嗽、咳痰、发热2+月入院,曾经给予多种抗菌药物治疗无缓解,后经过肺穿,病理结果证实为肺韦格肉芽肿,经过激素治疗后,患者症状明显缓解。结论肺部空洞可由多种原因引起,容易误诊,应尽早行活检明确肺部空洞的病因,针对性治疗,使患者早日康复。
Objective To explore the clinical manifestation and misdiagnosis reasons of one case of pulmonary Wegener′sgranulomatosis,and improve the level of diagnosis and treatment.Methods The clinical data of 1 case of patients ofpulmonary Wegener′s granulomatosis with cavity were retrospectively analyzed.Results Patient complains with coughing,sputum and fever for 2+ months in hospital.He was treated with a variety of antimicrobial agents,and the treatment was fail.After the lung puncture,the patient was diagnosed as lung Wegener′s granuloma and confirmed by pathology.The patientwas cured by hormone treatment.Conclusion The lung cavity can be caused by a variety of causes,and can be easilymisdiagnosed.Early biopsy should be done to confirm the cause of lung cavity,and to provide targeted treatment for theearly recover of the patient.
Objective To explore the clinical manifestation and misdiagnosis reasons of one case of pulmonary Wegener′sgranulomatosis,and improve the level of diagnosis and treatment.Methods The clinical data of 1 case of patients ofpulmonary Wegener′s granulomatosis with cavity were retrospectively analyzed.Results Patient complains with coughing,sputum and fever for 2+ months in hospital.He was treated with a variety of antimicrobial agents,and the treatment was fail.After the lung puncture,the patient was diagnosed as lung Wegener′s granuloma and confirmed by pathology.The patientwas cured by hormone treatment.Conclusion The lung cavity can be caused by a variety of causes,and can be easilymisdiagnosed.Early biopsy should be done to confirm the cause of lung cavity,and to provide targeted treatment for theearly recover of the patient.
引文
[1]梁东风,刘小兵,黄烽,等.韦格纳肉芽肿病的临床和病理分析[J].中华风湿病学杂志,2003,7(8):482-486.Liang DF,Liu XB,Huang F,et al.Clinical and pathological analysis of Wegener granulomatosis patients[J].Chin J Rheumatol,2003,7(8):482-486.
[2]Graves N.Wegener granulomatosis[J].Proc(Bayl Univ Med Cent),2006,19(4):342-344.
[3]罗慰慈.现代呼吸病学[M].北京:人民军医出版社,1997.Luo WC.Modern respiratory medicine[M].Beijing:People′s Military Medical Publishing House,1997.
[4]丁华野,皋岚湘,田玉旺,等.全身性韦格内肉芽肿病─附2例尸检研究[J].诊断病理学杂志,1995,2(3):137-139,194.Ding HY,Mou LX,Tian YW,et al.Systemic Wegner′s granulomatosis(A study of two autopsy cases)[J].J Diag Pathol,1995,2(3):137-139,194.
[5]Gaffo AL.Diagnostic approach to ANCA-associated vasculitides[J].Rheum Dis Clin North Am,2010,36(3):491-506.
[6]Seo P,Stone JH.The antineutrophil cytoplasmic antibodyassociated vasculitides[J].Am J Med,2004,117(1):39-50.
[7]张秀琴.抗中性粒细胞胞质抗体抗髓过氧化物酶抗蛋白酶3在系统性血管炎和其他自身免疫病中的临床意义[J].实用医技杂志,2017,24(5):478-480.Zhang XQ.The clinical significance of antineutrophil cytoplasmic antibodies,anti-myeloperoxidase antibodies and anti-proteinase3 antibodies in systemic vasculitis and other autoimmune diseases[J].Journal of Practical Medical Techniques,2017,24(5):478-480.
[8]孙凤霞,岳军艳.肺部韦格肉芽肿病的CT特征分析[J].中国临床医学影像杂志,2007,18(11):761-763.Sun FX,Yue JY.CT manifestation′s analysis of wegener granulomatosis in lung[J].J Chin Clin Med Imaging,2007,18(11):761-763.
[9]Levine D,Akikusa J,Manson D,et al.Chest CT findings in pediatric Wegener’s granulomatosis[J].Pediatr Radiol,2007,37(1):57-62.
[10]Pretorius ES,Stone JH,Hellman DB,et al.Wegener′s Granulomatosis:CT evolution of pulmonary parenchymal findings in treated disease[J].Crit Rev Comput Tomogr,2004,45(1):67-85.
[11]Lohrmann C,Uhl M,Kotter E,et al.Pulmonary manifestations of Wegener granulomatosis:CT findings in 57 patients and a review of the literature[J].Eur J Radiol,2005,53(3):471-477.
[12]万齐,赵康艳,李新春,等.肺韦格纳肉芽肿病CT征象分析[J].放射学实践,2013,28(11):1128-1131.Wan Q,Zhao KY,Li XC,et al.Analysis of CT features of Pulmonary Wegener’s Granulomatosis[J].Radiol Practice,2013,28(11):1128-1131.
[13]孙伟明.韦格纳肉芽肿18例分析[J].中国误诊学杂志,2007,7(2):338-339.Sun WM.Analysis of 18 cases of Wegener′s granulomatosis[J].Chin J Misdiagn,2007,7(2):338-339.
[14]黄玲.肺Wegener肉芽肿的CT分析[J].四川医学,2011,32(10):1647-1648.Huang L.CT analysis of Wegener’s granulomatosis of lung[J].Sichuan Medical Journal,2011,32(10):1647-1648.
[15]Martinez F,Chung JH,Digumarthy SR,et al.Common and uncommon manifestations of Wegener granulomatosis at chest CT:Radiologic-pathologic correlation[J].Radiographics,2012,32(1):51-69.
[16]Hoffman GS,Kerr GS,Leavitt RY,et al.Wegener granulomatosis:An analysis of 158 patients[J].Ann Intern Med,1992,116(6):488-498.
[17]中华医学会风湿病学分会.韦格纳肉芽肿病诊断和治疗指南[J].中华风湿病学杂志,2011,15(3):194-196.Rheumatology Branch Association of Chinese Medical Association.Guidelines for the diagnosis and treatment of Wegener′s granulomatosis[J].Chin J Rheumatol,2011,15(3):194-196.
[2]Graves N.Wegener granulomatosis[J].Proc(Bayl Univ Med Cent),2006,19(4):342-344.
[3]罗慰慈.现代呼吸病学[M].北京:人民军医出版社,1997.Luo WC.Modern respiratory medicine[M].Beijing:People′s Military Medical Publishing House,1997.
[4]丁华野,皋岚湘,田玉旺,等.全身性韦格内肉芽肿病─附2例尸检研究[J].诊断病理学杂志,1995,2(3):137-139,194.Ding HY,Mou LX,Tian YW,et al.Systemic Wegner′s granulomatosis(A study of two autopsy cases)[J].J Diag Pathol,1995,2(3):137-139,194.
[5]Gaffo AL.Diagnostic approach to ANCA-associated vasculitides[J].Rheum Dis Clin North Am,2010,36(3):491-506.
[6]Seo P,Stone JH.The antineutrophil cytoplasmic antibodyassociated vasculitides[J].Am J Med,2004,117(1):39-50.
[7]张秀琴.抗中性粒细胞胞质抗体抗髓过氧化物酶抗蛋白酶3在系统性血管炎和其他自身免疫病中的临床意义[J].实用医技杂志,2017,24(5):478-480.Zhang XQ.The clinical significance of antineutrophil cytoplasmic antibodies,anti-myeloperoxidase antibodies and anti-proteinase3 antibodies in systemic vasculitis and other autoimmune diseases[J].Journal of Practical Medical Techniques,2017,24(5):478-480.
[8]孙凤霞,岳军艳.肺部韦格肉芽肿病的CT特征分析[J].中国临床医学影像杂志,2007,18(11):761-763.Sun FX,Yue JY.CT manifestation′s analysis of wegener granulomatosis in lung[J].J Chin Clin Med Imaging,2007,18(11):761-763.
[9]Levine D,Akikusa J,Manson D,et al.Chest CT findings in pediatric Wegener’s granulomatosis[J].Pediatr Radiol,2007,37(1):57-62.
[10]Pretorius ES,Stone JH,Hellman DB,et al.Wegener′s Granulomatosis:CT evolution of pulmonary parenchymal findings in treated disease[J].Crit Rev Comput Tomogr,2004,45(1):67-85.
[11]Lohrmann C,Uhl M,Kotter E,et al.Pulmonary manifestations of Wegener granulomatosis:CT findings in 57 patients and a review of the literature[J].Eur J Radiol,2005,53(3):471-477.
[12]万齐,赵康艳,李新春,等.肺韦格纳肉芽肿病CT征象分析[J].放射学实践,2013,28(11):1128-1131.Wan Q,Zhao KY,Li XC,et al.Analysis of CT features of Pulmonary Wegener’s Granulomatosis[J].Radiol Practice,2013,28(11):1128-1131.
[13]孙伟明.韦格纳肉芽肿18例分析[J].中国误诊学杂志,2007,7(2):338-339.Sun WM.Analysis of 18 cases of Wegener′s granulomatosis[J].Chin J Misdiagn,2007,7(2):338-339.
[14]黄玲.肺Wegener肉芽肿的CT分析[J].四川医学,2011,32(10):1647-1648.Huang L.CT analysis of Wegener’s granulomatosis of lung[J].Sichuan Medical Journal,2011,32(10):1647-1648.
[15]Martinez F,Chung JH,Digumarthy SR,et al.Common and uncommon manifestations of Wegener granulomatosis at chest CT:Radiologic-pathologic correlation[J].Radiographics,2012,32(1):51-69.
[16]Hoffman GS,Kerr GS,Leavitt RY,et al.Wegener granulomatosis:An analysis of 158 patients[J].Ann Intern Med,1992,116(6):488-498.
[17]中华医学会风湿病学分会.韦格纳肉芽肿病诊断和治疗指南[J].中华风湿病学杂志,2011,15(3):194-196.Rheumatology Branch Association of Chinese Medical Association.Guidelines for the diagnosis and treatment of Wegener′s granulomatosis[J].Chin J Rheumatol,2011,15(3):194-196.