多系統結節病誤診為淋巴瘤一例并文獻分析_《中國呼吸與危重監護雜志》

作者：

1. 上海交通大學醫學院附屬新華醫院呼吸科(上海 200092);;
2. 上海交通大學醫學院附屬新華醫院病理科(上海 200092);

關鍵詞：

多系統結節病診斷治療體層攝影術病理

DOI：

10.7507/1671-6205.2014044

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目的提高對多系統結節病的認識及診治水平,避免漏診、誤診。方法結合相關文獻復習對1例多系統結節病患者的診治進行分析。結果患者表現為咳嗽、咳痰,臨床癥狀無特異性。結節病最易侵犯肺及其他胸部臟器,胸部增強CT特點為雙側肺門淋巴結對稱性增大,伴或不伴縱隔淋巴結增大,腫大淋巴結邊界清楚,強化均勻,未見融合。PET/CT顯像中腫大淋巴結多呈結節樣、對稱分布。支氣管鏡下可見支氣管黏膜炎癥和黏膜結節。結節病的確診依靠病理學檢查。典型的結節病病理表現為散在、緊密的非干酪樣壞死性肉芽腫。激素治療有效。結論結節病是一種病因不明的全身多系統疾病,缺乏特異性臨床表征,因而容易誤診。影像學檢查及相關實驗室檢查有助于結節病的診斷。確診依靠病理檢查。

引用本文： 張悅, 韓鋒鋒, 郭雪君, 管雯斌, 孫晉淵, 宋琳, 戈霞暉. 多系統結節病誤診為淋巴瘤一例并文獻分析. 中國呼吸與危重監護雜志, 2013, 12(2): 185-189. doi: 10.7507/1671-6205.2014044 復制

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14.	Tremblay A,Stather DR,Maceachern P,et al.A randomized controlled trial of standard vs endobronchial ultrasonography-guided transbronchial needle aspiration in patients with suspected sarcoidosis.Chest,2009,136:340-346.
15.	Nakajima T,Yasufuku K,Kurosu K,et al.The role of EBUS-TBNA for the diagnosis of sarcoidosis--comparisons with other bronchoscopic diagnostic modalities.Respir Med,2009,103:1796-1800.
16.	Navani N,Booth HL,Kocjan G,et al.Combination of endobronchial ultrasound-guided transbronchial needle aspiration with standard bronchoscopic techniques for the diagnosis of stage I and stage II pulmonary sarcoidosis.Respirology,2011,16:467-472.

1. Polychronopoulous VS,Prakash UB.Airway involvement in sarcoidosis.Chest,2009,136:1371-1380.
2. Clement DS,Postma G,Rothova A,et al.Intraocular sarcoidosis of clinical characteristics of uveitis with positive chest high-resolution computed tomography findings.Br J Ophthalmol,2010,94:219-222.
3. Costabel U,Ohshimoa S,Guzman J.Diagnosis of sarcoidosis.Curr Ooin Pulm Med,2008,14:455-461.
4. 鄧文靜,楊嵐.結節病19例臨床分析.中國呼吸與危重監護雜志,2012,11:176-179.
5. 關志偉,姚樹林,王瑞民,等.22例結節病¹⁸F-FDG PET/CT影像學特征分析.中華核醫學雜志,2011,31:334-338.
6. Kruger S,Buck AK,Mottaghy FM,et al.Use of integrated FDG PET/CT in sarcoidosis.Clinical Imaging,2008,32:269-273.
7. Malasamy S,Dala B,Bimenyuy C,et al.The clinical and radiologic features of nodular pulmonary sarcoidosis.AJR, 2009,187:9-15.
8. Michael CI,Benjamin AR,Alvin ST.Sarcoidosis.N Eng J Med,2007,357:2153-2165.
9. Boros PW,Enright PL,Quanjer PH,et al.Impaired lung compliance and DL,CO but no restrictive ventilatory defect in sarcoidosis.Eur Respir J,2010,36:1315-1322.
10. Danila E,Jurgauskiene L,Malickaite R.BAL fluid cells and pulmonary function in different radiographic stages of newly diagnosed sarcoidosis.Adv Med Sci,2008,53:228-233.
11. Gerke AK,Hunninghake G.The immunology of sarcoidosis.Clin Chest Med,2008,29:379-390.
12. 金兒,任振義,王利民.臨床常用的幾種檢查方法在胸部結節病診斷和分期中的應用價值.醫學研究雜志,2007,36:111-113.
13. Judson MA.The diagnosis of sarcoidosis.Clin Chest Med,2008,29:415-427.
14. Tremblay A,Stather DR,Maceachern P,et al.A randomized controlled trial of standard vs endobronchial ultrasonography-guided transbronchial needle aspiration in patients with suspected sarcoidosis.Chest,2009,136:340-346.
15. Nakajima T,Yasufuku K,Kurosu K,et al.The role of EBUS-TBNA for the diagnosis of sarcoidosis--comparisons with other bronchoscopic diagnostic modalities.Respir Med,2009,103:1796-1800.
16. Navani N,Booth HL,Kocjan G,et al.Combination of endobronchial ultrasound-guided transbronchial needle aspiration with standard bronchoscopic techniques for the diagnosis of stage I and stage II pulmonary sarcoidosis.Respirology,2011,16:467-472.

《中國呼吸與危重監護雜志》

多系統結節病誤診為淋巴瘤一例并文獻分析

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《中國呼吸與危重監護雜志》

多系統結節病誤診為淋巴瘤一例并文獻分析

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