接触粉尘工人尘肺与结节病误诊病例分析
Misdiagnosis of Pneumoconiosis and Sarcoidosis among Dust Exposed Workers
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摘要:
目的 通过对肺部结节病误诊为尘肺或尘肺误诊为结节病的胸部影像学检查病例进行回顾性分析,探讨二者诊断方法及误诊原因。 方法 对21 例误诊病例的影像学表现进行分析,结合相关临床、实验室等资料,总结尘肺与结节病相互误诊的原因及鉴别方法。 结果 21 例均有接尘史的误诊病例中,6 例尘肺病误诊为结节病,15 例结节病误诊为尘肺。5 例仅有肺部病变而无胸部淋巴结增大,16 例有胸部淋巴结增大;肺部病变中,15 例为多发小结节或微结节,1 例肺内广泛纤维化,8 例分别经支气管镜及前斜角肌脂肪垫活检证实为结节病。 结论 尘肺与结节病的鉴别诊断有一定困难,需密切结合相关职业史或临床、实验室等资料,重点分析系列影像学表现,为临床诊断提供依据。 Abstract:Objective To understand the misdiagnosis between pneumoconiosis and sarcoidosis by retrospectively analyzing the chest radiographs and explore the differential diagnostic issue of these two diseases. Methods Imaging findings of 21 misdiagnosed cases were analyzed, in combination of clinical and laboratory data, to conclude the causes of misdiagnosis and differentiation of pneumoconiosis and sarcoidosis. Results According the medical records of the 21 cases that had a history of dust exposure, 6 cases of pneumoconiosis were misdiagnosed as sarcoidosis, and 15 cases of sarcoidosis were misdiagnosed as pneumoconiosis; 5 cases presented lung lesion without chest lymph node enlargement, and the other 16 cases presented chest lymph nodes enlargement. Multiple small nodules or micronodules were found in 15 cases, extensive fibrosis pulmonary was found 1 case, and 8 cases were confirmed as sarcoidosis after bronchoscopy and scalene fat pad biopsy. Conclusion There are certain difficulties in the differential diagnosis of pneumoconiosis and sarcoidosis, and thus relevant occupational history, clinical and laboratory data should be considered in analyzing imaging findings to provide diagnostic evidence.
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