肺部子宫内膜异位症误诊分析

目的探讨肺部子宫内膜异位症(pulmonary endometriosis,PEM)的影像学特征、诊治方法、误诊原因。方法回顾分析我院收治的32例PEM的临床资料。结果本组以经期出现胸痛、胸闷为主要症状就诊,其中首诊误诊26例,误诊率81%,12例误诊为肺结核、10例误诊为肺部感染、4例误诊为肺部肿瘤。本组11例病情较重者经胸腔镜手术活检确诊PEM,另21例病情较轻者经糖皮质激素治疗有效,结合患者肺部病变随月经周期性改变特征,修正诊断为PEM。11例病情较重者予促性腺激素释放激素激动剂(GnRH-a)联合胸腔镜手术治疗,21例病情较轻者予GnRH-a保守治疗,预后均较好。结论PEM的CT表现具有多样性,与患者生理周期密切相关,多个月经周期的影像学复诊,并结合症状随患者月经周期性改变特征,能给予临床更多的提示,无需病理学检查即可确诊。

Misdiagnosis of Pulmonary Endometriosis

Objective To investigate the imaging features,diagnosis and treatment,and cause of misdiagnosis of pulmonary endometriosis(PEM).Methods We retrospectively analyzed the clinical data of 32 cases of PEM who were admitted to our hospital.Results This group of patients presented with chest pain and tightness during menstruation as the main clinical symptoms.Among them,26 cases were misdiagnosed at the initial diagnosis(misdiagnosis rate was 81%),including 12 cases misdiagnosed as tuberculosis,10 cases as pulmonary infection,and 4 cases as lung tumors.Eleven patients with severe disease in this group were diagnosed with PEM by thorascopic biopsy,and 21 patients with mild disease responded well to hormonal therapy.Based on the characteristics of lung disease that were changed periodically,the diagnosis was corrected as PEM.Eleven patients with severe disease were treated with gonadotropin-releasing hormone agonist(GnRH-a)combined with thorascopic surgery,while 21 patients with mild disease were given conservative treatment with GnRH-a.The prognosis was favorable.Conclusion The CT findings of PEM are highly diverse,which are closely related to the physiological cycle of the patients.The imaging review of multiple menstrual cycles,combined with the symptoms showing typical periodic changes with the patient’s menstruation,can give more clinical tips and provide diagnosis without pathological examination.