肺动静脉瘘长期误诊为肺结核12例分析

目的提高对肺动静脉瘘与肺结核病的诊断水平。方法1990年1月至2005年10月确诊为肺动静脉瘘而在外院长期误诊为肺结核的12例进行回顾分析。结果12例病人均曾被外院长期误诊为肺结核,抗结核治疗时间长短不等,最后确诊。结论结核发病率升高,使临床医生对结核的警惕性普遍增强;肺动静脉瘘和肺结核的临床表现不典型及X线胸片的多样性导致了误诊率的增加。结核病专科医师应打破结核的思维定势,包括综合性医院的医师均应熟悉包括肺动静脉瘘在内的多种肺部疾病,提高肺动静脉瘘和肺结核的诊断与鉴别水平。对痰检阴性肺结核的诊断应慎重,积极通过其他途径确诊,经验性抗结核治疗后应及时复查X线胸片,以确定诊断。胸部CT(增强)或肺动脉造影检查对肺动静脉瘘的诊断、鉴别诊断有重要作用。

Twelve cases with pulmonary arteriovenous fistula are misdiagnosed as pulmonary tuberculosis for long term

Objective To improve the differential diagnosis level of pulmonary arteriovenous fistula(PAVF) and pulmonary tuberculosis(PTB). Methods Retrospective analysis was conducted on 12 PAVF cases diagnosed in our hospital who were misdiagnosed as PTB for long term in other hospitals from January,1990 to October,2005. Results 12 cases were misdiagnosed as PTB in other hospitals for long term and had anti-TB treatment for different duration and was confirmed as PAVF in our hospital. Conclusion As the TB incidence increased,clinical doctor's vigilance to TB strengthened generally.The atypical clinical manifestation of PAVF and PTB and variety of chest lX-ray films increased the misdiagnosing rate.TB doctors should break the regular thought of TB,including the understanding of different pulmonary diseases such as PAVF and increase the level of diagnosis and differential diagnosis of PAVF and PTB.Attention should be paid to the diagnosis of smear negative PTB and the confirmation of the diagnosis should be made through other approach.The anti-TB treatment based on experience should be followed by re-examination of Chest X-ray to confirm the diagnosis.Chest CT(strengthened) or lung artery radiography play an important role on diagnosis and differential diagnosis of PAVF.