22例误诊为周围型肺癌的肺隐球菌病患者临床分析

Analysis on 22 cases of pulmonary cryptococcosis misdiagnosed as peripheral lung cancer

关键词:  隐球菌病  肺癌  误诊  CT

Key words:  pulmonary cryptococcosis  lung cancer  misdiagnosis  CT scan

摘要:

目的　探讨肺隐球菌病（pulmonary cryptococcosis, PC）临床特点及误诊原因，提高对该病的诊断水平。方法　回顾性分析大连医科大学附属第一医院呼吸内科2005年8月至2016年6月22例误诊为周围型肺癌的PC临床资料。22例PC患者中男12例（55%），女10例（45%）；无症状12例（55%）、咳嗽或咳痰6例（27%）、胸闷和气短4例（18%）、胸痛3例（14%）、痰中带血2例（9%）。影像学主要表现为肺部肿块/结节型16例（73%）；肺实变型6例（27%）；单侧分布21例（95%），肺下叶13例（59%）。20例行外科手术，2例经皮穿刺肺活检。结果　22例经病理证实为PC。16例术后未行抗真菌治疗，其中3例随诊未见复发。术后4例予氟康唑（400 mg/d，口服）治疗3~6个月，随诊未见复发。未手术2例予氟康唑（400 mg/d，口服）治疗6~12个月，复查病灶明显缩小、吸收。结论　PC患者临床表现及影像学均无特异性，易误诊为周围型肺癌。肺部多发或单发肿块/结节型是主要影像学特点，怀疑PC时应首先行经皮穿刺肺活检以取得病理诊断。

Abstract:

Objective To investigate the clinical characteristics and diagnosis of pulmonary cryptococcosis and imprve the diagnosis. Methods A retrospective analysis was conducted on 22 cases of pulmonary cryptococcosis misdiagnosed in our hospital during August 2005 and June 2016. Results Among the 22 patients, 14 were male（55%）and 10 were female（45%）. Twelve patients (55%) were asymptomatic. 6 patients (27%) had cough or sputum. 4 patients had shortness of breath(18%),3 patients had chest pain(14%), 2 patients had bloody sputum(9%). The main manifestations of chest CT scan included pulmonary mass or nodule (16 cases，73%） and parenchymal consolidation (6 cases，27%）. The majority of the lesions were unilateral (21 cases, 95%），especially in the lower lobe (13 cases, 59%）. Twenty patients after surgery underwent thoracic surgery and the other two patients had transthoracic biopsy. Results Pulmonary cryptococcosis was confirmed in all of the 22 patients by pathological examination. Sixteen patients did not receive antifungal treatment after surgery. Among them, 3 patients were followed up for 3 months without recurrence. Four patients with surgery were treated by oral fluconazole (400 mg/d) for 3-6 months without recurrence. The lesions in 2 patients without surgery were obviously diminished or absorbed after taking oral fluconazole (400 mg/d) for 6-12 months. Conclusion Pulmonary cryptococcosis is lack of specific clinical and imaging findings and easily misdiagnosed as peripheral lung cancer. The main imaging features are pulmonary mass or nodule. For patients with atypia lesions，transthoracic pathological biopsy is an effective，reliable and safe method for the diagnosis of pulmonary cryptococcosis.