骨化性气管支气管病

目的 探讨骨化性气管支气管病（TO）的临床特征、诊断和治疗。方法 对TO患者行影像学、肺功能、支气管镜及病理学检查并结合文献分析其临床特点。结果 TO是指气管粘膜下有多发性骨质和软骨组织结节状增生并突向管腔。1999年6月－2000年5月经纤维支气管镜检查（纤支镜检）TO的阳性率为0．35％（4／1125）,2男2女,35－60岁,既往行纤支镜检及活检均误诊。TO症状为咳嗽（3／4）、咳痰（2／4）、血丝痰（3／4）、声嘶（1／4）等,亦可无症状（1／4）,胸片均未见异常。CT示气管壁有不规则斑点状钙化影并突入管腔（3／4）。1例呈轻度阻塞性通气功能障碍,其余3例气道阻力测定有1例增加。纤支镜检气管壁可见特征性的大小不等结节突向管腔,质硬。病理均见粘膜下软骨和骨质结节状增生。1例给予丙酸倍氯米松和茶碱治疗,半年后症状、气管粘膜充血改善。结论 TO不是罕见病,易被漏诊、误诊,建议有关专著介绍此病。     

继发性肺结核合并巨块型骨化性气管支气管病一例

<正>骨化性气管支气管病(tracheobronchopathia osteochondroplastica,TO)是气管及支气管慢性进展性的多发性骨质或软骨组织结节状增生并突向管腔的良性病变，多数病因与患者自身软骨发育异常有关，是一种罕见病，发病率仅为0.11%^[1]。加之其临床表现缺乏特异性，某些患者仅以轻微的咳嗽、咳痰及胸闷、气喘等症状为表现，导致临床诊断较为困难，多数患者是在行支气管镜检查时由有经验的支气管镜医生观察到其典型镜下弥漫性结节样增生及气道狭窄表现而行组织病理学检查得以确诊。     

支气管镜对骨化性气管支气管病的诊治价值

目的 探讨支气管镜对骨化性气管支气管病的诊治价值,提高对该病的认识.方法 对中南大学湘雅医院呼吸科支气管镜室2006年6月至2007年7月收治的10例骨化性气管支气管病患者的临床症状、支气管镜下表现、组织病理结果 及支气管镜下治疗经过和疗效进行回顾性研究.结果 10例中男8例,女2例,年龄33～76岁,平均(46 ±16)岁.支气管镜下可见大小不一的结节凸向管腔,沿气管、支气管纵向分布,主要累积气管和主支气管,叶、段支气管较少累积;7例结节局限于气道前侧壁,3例同时累及后侧壁.按结节分布密度将其分为3型:分散型、弥漫型和融合型,分别为3例、5例和2例.6例接受治疗的患者中2例选用等离子射频治疗,4例选用氩气刀治疗.术中及术后均未出现严重并发症.治疗后患者气道内结节较治疗前减少,临床症状改善.结论 骨化性气管支气管病易误诊、漏诊;支气管镜联合组织病理检查是确诊的最佳手段;支气管镜下等离子射频和氩气刀治疗是有效的姑息治疗手段.     

骨化性气管支气管病4例及文献复习

目的:总结骨化性气管支气管病(TO)的临床特点，减少临床误诊率及漏诊率。方法:收集我院诊治的4例TO患者的临床资料，并检索国内数据库，总结116例TO患者的临床特点。结果:116例TO中男性65例，女性51例。临床表现无特异性，以组合性呼吸道症状多见。支气管镜检查可见气管及支气管前壁及侧壁黏膜下多发质硬结节，突向管腔，后壁不易受累。组织病理活检可见黏膜下出现软骨或成熟骨组织。治疗上对症处理，出现严重管腔狭窄可采用内镜介入或外科手术。结论：TO是一种预后较好的良性疾病， 支气管镜及组织病理活检有特征性改变,可以确诊。     

骨化性气管支气管病一例

正骨化性气管支气管病(tracheobroncheopathia osteochondroplastica,TO)是指气管、支气管黏膜下有多发性骨质或软骨组织结节样增生并突向管腔的良性气道病变~([1-2]),是一种极少见的主要累及呼吸系统大气道的良性疾病。目前国内对该疾病的报道较少,能够确诊的TO患者共79例(1991年至2016年)。在临床上此病易与肿瘤或结核     

气管支气管骨化症2例并文献复习

目的 提高对气管支气管骨化症的认识,提高疾病诊断率.方法 收集经郑州大学第一附属医院呼吸与危重症医学科确诊的气管支气管骨化症2例,对患者的临床症状,胸部CT、纤维支气管镜下表现、组织病理、治疗及效果进行回顾性研究,并复习相关文献对气管支气管骨化症进行分析.结果 2例患者均为女性,分别为55岁和33岁,均表现为咳嗽、咳痰,纤维支气管镜下可见结节样隆起突出气管、支气管管腔,质硬.1例患者经气道内结节高频电、氩气刀及冷冻治疗,另1例患者给予糖皮质激素口服治疗.2例患者治疗后患者临床症状较前均有所改善.结论 气管支气管骨化症临床症状各异,临床医师、影像学医师对气管支气管骨化症认识不足,导致该病诊断率低,易被误诊、漏诊,对原因不明的慢性咳嗽患者应行支气管镜检查排除气管支气管骨化症.     

气管支气管结核早期多层螺旋CT诊断（附22例报告分析）

目的了解气管支气管结核的早期16层螺旋CT影像表现，评价多层螺旋CT诊断支气管结核的价值。方法对22例经手术病理和纤维支气管镜活检证实的气管支气管结核分别进行MPR重建成像，分析其影像学表现。结果支气管结核的16层螺旋CT表现有以下特点：（1）多支段受累，好发于上肺叶及中肺叶；（2）病变支气管范围长，多为主支气管、叶支气管、段支气管连续或间断受累；（3）管腔多为不规则狭窄；（4）管壁多为不规则增厚，密度增高或钙化。22例气管支气管结核患者中，16支病变支气管表现为支气管壁不同程度向心性增厚，内壁呈浅波浪状。22例均合并肺内结核，肺内结核病灶多数分布于病变支气管所属肺组织。结论16层螺旋CT对显示气管、支气管内膜结核的累及范围有一定的优势，对支气管结核的早期诊断及治疗方法的选择有较高的临床应用价值。     

气管支气管巨大症临床特征及影像学表现

目的 探讨气管支气管巨大症的临床诊断及治疗,提高对气管支气管巨大症的认识.方法 分析气管支气管巨大症的临床特点、影像学表现、纤维支气管镜特征及临床诊断,并复习相关文献.结果 患者以反复咳嗽、咳黄脓痰、阵发性胸闷气促为特点,胸部CT检查显示气管、左右主支气管直径明显增大,纤维支气管镜下显示气管、支气管管腔扩张,软骨显露明...     

骨化性气管支气管病2例

正骨化性气管支气管病(tracheobronchopathia osteochondroplastica TO)是指气管、支气管黏膜下多发性骨质或软骨组织结节状增生,并向管腔突起的良性病变,是一种少见的气道疾病。由于本病临床表现不典型,同时临床医生对本病认识不足,容易造成误诊漏诊,现报告我院2012年11月和2013年6月期间经病理诊断的2例病例并结合文献复习,以提高对本病的认识。病例资料病例1,患者,雷女士,女,38岁,以咳嗽、咳黄脓     

以呼吸道损害为唯一表现的复发性多软骨炎1例并文献回顾

目的探讨以呼吸道损害为唯一表现的复发性多软骨炎(RP)的临床特征、诊断及治疗。方法分析我院1例经计算机体层摄影术CT及支气管软骨活检术后病理诊断的RP患者的临床资料,并结合文献进行复习。结果患者为老年男性,以发热、咳嗽、咳痰为主要表现,肺功能示阻塞性通气功能障碍,胸部CT示气管主支气管管壁增厚,纤维支气管镜检查示气管支气管软骨环消失、管腔狭窄,病理检查为慢性炎症。予以糖皮质激素治疗有效。结论 RP以呼吸道单独受累的较为罕见,而呼吸系统受累常提示预后不佳,是该疾病死亡的主要原因。呼吸系统首先受累时,诊断是困难的且病情容易被耽误。影像学检查及软骨活检有助于诊断。治疗方式包括糖皮质激素或糖皮质激素联合免疫抑制剂等药物治疗及纤维支气管镜下气道成形术。     

成人血行播散性肺结核202例临床及影像分析

目的通过对血行播散性肺结核临床资料的分析,提高对该病的认识。方法回顾性分析1998—2008年收治的成人血行播散性肺结核202例的临床资料、影像学特点、误诊情况及治疗反应。结果（1）中青年患者占80.2%, 老年患者占19.8%。（2）痰涂片查抗酸杆菌（AFB)阳性率为20.7%;31例AFB阴性患者中35.5%纤维支气管镜检抗酸杆菌阳性。（3）12.9%X线胸片早期表现为肺间质磨玻璃样改变,51.5%表现为大小、密度、分布均匀的粟粒结节。（4）胸部高分辨CT显示55.0%急性血行播散型表现双肺弥漫分布的大小、密度均匀的粟粒结节;另48例亚急性和慢性血行播散性肺结核表现以上中肺野为主的3～7mm大小、密度及分布不均匀的结节。46.8%的肺野内可见斑片、结节、纤维条索状影;43.1%伴纵隔和/或肺门淋巴结肿大。（5）20例活组织检查60%病理阳性。 （6）44.6%合并肺外结核,常见于脑膜、浆膜腔、淋巴结、脑、肝、脾、骨等。（7）42.1%入院前被误诊为其他疾病。（8）除8例外其余患者抗结核治疗后体温在3d到12周内降至正常。（9）79.7%在抗结核治疗2个月后胸片显示病灶不同程度吸收。结论痰涂片、HRCT、纤维支气管镜及器官组织活检是早期诊断的关键。     

19例支气管结核患儿的临床特征及误诊情况分析

收集2010年1月至2016年12月南京市胸科医院结核科确诊的支气管结核患儿共19例,对其胸部影像学表现、发病部位及支气管镜检查结果进行回顾性分析;所有患儿入院前均曾被误诊,对其误诊情况进行总结。19例患儿中,10例CT扫描表现为肺部大片状高密度影,其余9例有斑点斑片影;支气管镜下表现为溃疡坏死型8例,炎症浸润型6例,疤痕狭窄型3例,肉芽增殖型2例;根据支气管镜下所见(取病变最严重的部位),支气管结核位于上叶10例,下叶基底段4例,背段支气管3例,左主支气管2例;19例患儿中,17例主要症状为慢性咳嗽,11例存在胸闷不适;因症状不典型,在入我院前曾被误诊为支气管炎7例,咳嗽变应性哮喘4例,支原体肺炎3例,支气管哮喘2例,上气道咳嗽综合征2例,感染后咳嗽1例。作者认为,儿童支气管结核临床特征缺乏特异性,在临床诊疗中易被误诊,需要提高警惕,尽早行气管镜相关检查。     

支气管镜检对不明原因胸闷患者的诊断价值研究

目的利用电子支气管镜对不明原因胸闷患者进行检查。方法收集我院呼吸内科门诊不明原因胸闷患者78例,电子支气管镜检查,并行支气管刷检、活检、支气管肺泡灌洗液检查。结果支气管镜检查显示:支气管肺癌19例(24.4%),炎性改变17例(21.8%),支气管结核11例(14.1%),痰栓所致肺不张8例(10.3%),支气管异物6例(7.7%),支气管狭窄2例(2.6%),支气管正常改变15例(19.2%)。灌洗液发现可疑肿瘤细胞10例(12.8%),灌洗培养阳性12例(15.4%);黏膜刷检11人次发现抗酸杆菌(14.1%),发现可疑肿瘤细胞6例(7.7%);肿物活检:结核结节7例(9.0%),鳞癌14例(17.9%)腺癌5例(6.4%)。结论电子支气管镜检查及支气管黏膜刷检、肺泡灌洗液、活检,对不明原因胸闷患者病因诊断有重要意义。     

The value of flexible bronchoscopy in childhood pulmonary tuberculosis

The value of 121 flexible bronchoscopy (FB) procedures was evaluated in 54 children, aged three months to 14 years, suspected of having pulmonary tuberculosis. Specimens from FB were culture-positive for Mycobacterium tuberculosis in seven of the 13 bacteriologically confirmed cases. Bronchial abnormalities consistent with the diagnosis were found in 31 of 54 cases. Separate or coexistent findings at initial FB included airway compression (20 cases), granulation tissue (ten cases), and obstructive caseum (four cases). Chest roentgenograms underestimated bronchial involvement in 14 children. Further FB monitoring documented disease evolution. The FB was important in the management of patients, as it (1) guided the use of prednisone therapy, especially in the children with a chest roentgenogram not suggestive of bronchial involvement; (2) indicated a need for resection of granulation tissue by rigid bronchoscopy (three cases); and (3) guided the surgical decision (two children with persistent bronchial obstruction). Thus, FB is a safe and valuable procedure in the management of childhood pulmonary tuberculosis.     

Clinical aspects of miliary tuberculosis in Saudi adults.

OBJECTIVE: To review all cases of miliary tuberculosis (MT) over a period of 7 years in a Saudi Arabian population, to determine the clinical and laboratory characteristics and diagnostic methods, and to compare our data with others reported in the literature. DESIGN: A retrospective case review. RESULTS: Of 780 cases of active tuberculosis seen over period of 7 years, 47 (6%) had MT. The majority of the patients were aged over 60 years (68%). The most common symptoms were fever and weight loss. Risk factors were present in 70% of cases, mainly diabetes mellitus, history of prior tuberculosis, chronic liver and renal disease, immunosuppressive drug therapy and malignancy. Miliary pattern on chest radiography was seen in 89%. The most common laboratory abnormalities were anemia (66%), lymphopenia (89%), low albumin (87%), and high alkaline phosphatase (80%). Fiberoptic bronchoscopy was diagnostic in 7/10 (70%), bone marrow examination in 8/11 (73%), and liver biopsy in 14/16 (88%). High alkaline phosphatase and lymphopenia were associated with high yield of liver biopsies and bone marrow examination: 13/14 (93%) and 7/8 (88%), respectively. Death occurred in 10/47 (21%); all of these had radiological evidence of miliary pattern, and 80% had comorbid conditions. CONCLUSION: These data confirm and extend the results of other studies and suggest that MT is a disease of the elderly and immunocompromised, and is associated with high mortality. A high index of suspicion is required for diagnosis.     

儿童气管支气管结核临床和支气管镜下的表现特征

目的 分析儿童气管支气管结核(tracheobronchial tuberculosis,TBTB)的临床相关因素及支气管镜下特点,为TBTB的早期诊断提供线索。方法 回顾性分析2006年7月至2014年12月首都医科大学附属北京儿童医院收住入院并进行了支气管镜检查的肺结核患儿240例,最终根据支气管镜检查结果确诊TBTB 130例(简称“TBTB组”),非TBTB的肺结核 110例(简称“非TBTB组”)。对两组患儿的基本资料、临床表现、影像学特征、支气管镜下特点等进行分析比较。使用SPSS 22.0软件进行统计学分析,计量资料采用秩和检验,计数资料采用χ ²检验,病灶位置的数目和年龄的相关性采用Spearman等级相关检验, P<0.05为差异有统计学意义。 结果 TBTB组患儿的中位年龄[(1.6岁(四分位数:0.8岁,5.5岁)]显著低于非TBTB组[4.5岁(四分位数:1.1岁,10.1岁)](U=5309.500,P=0.001)。TBTB组年龄<2岁的患儿占57.7%(75/130),高于非TBTB组的34.5%(38/110)(χ ²=12.813,P=0.000)。喘息与气促症状的发生率在TBTB组(23.1%,30/130)显著高于非TBTB组(5.5%,6/110)(χ ²=14.513,P=0.000)。TBTB组结核分枝杆菌培养阳性率(21.5%,28/130)显著高于非TBTB组(7.3%,8/110)(χ ²=9.510,P=0.002)。TBTB组患儿胸部CT有22.3%(29/130)存在气道阻塞征象,显著高于非TBTB组(4.5%,5/110)(χ ²=15.460,P=0.000)。通过支气管镜检查,TBTB组患儿淋巴结瘘型(lymph node erosion,LNE)占95.4%(124/130),干酪样肺炎侵蚀破坏临近支气管(caseous pneumonia erosion, CPE)者占6.2%(8/130)。初次镜检时,77.7%(101/130)的TBTB患儿为淋巴结瘘型破溃期,17.7%(23/130)为淋巴结瘘型破溃前期。TBTB最常见累及右主支气管(33例)、右支气管中间段(32例)和右上叶支气管(30例)。单个肺叶支气管受累的TBTB患儿的中位数年龄[2.2岁(四分位数:1.0岁,6.1岁)]显著高于多个肺叶支气管受累患儿[1.0岁(四分位数:0.5岁,1.8岁)](U=1176.500,P=0.002),且受累肺叶支气管的数目与患儿年龄呈负相关(Pearson相关系数=-0.222,P=0.011)。 结论 对于有喘息和气促表现、胸部影像提示气道阻塞的肺结核患儿,需高度怀疑TBTB,及早行支气管镜检查以明确诊断。     

Characteristics of endobronchial tuberculosis under fiberbronchoscopy

Thirty five cases of tuberculosis of bronchial endometrium proved by bronchoscopy and biopsy were reported. More than half of them are young patients below 35 years old. Chief complaints are cough and chest pain. 38.5% of them had atelectasis revealed by x-ray. Granuloma, congestion edema and narrowing of the lumen of the bronchi were characteristic features under the bronchoscopy, 29% of them were misdiagnosed as bronchogenic carcinoma before the bronchoscopy; therefore, the procedure is important in the diagnosis of tuberculosis of endometrium of bronchi.     

The role of routine culture for tuberculosis during bronchoscopy in a nonendemic area: analysis of 300 cases and review of the literature

BACKGROUND: Many centers routinely culture bronchoscopy samples for mycobacteria, even when tuberculosis (TB) is not strongly suspected. The value of this practice is poorly defined in areas with a low prevalence of TB. METHODS: A retrospective observational study was conducted in tertiary care, university-affiliated medical center and included 300 consecutive patients who underwent a bronchoscopy examination. The findings for acid-fast bacillus (AFB) staining and culture were reviewed, and data on demographic characteristics, presenting symptoms, old TB, autoimmune status, and chest x-ray results were collected from the files. RESULTS: The study included 175 men (58%) and 125 women, with a mean age of 62 +/- 25 years. Eight cultures (2.67%) grew mycobacteria: 4 (1.33%) Mycobacterium tuberculosis and 4 (1.33%) nontuberculous mycobacteria (NTM). Thus, the incidence of TB was 4 of 300 (1.33%) patients. There were no cases of positive AFB smear or culture in patients with atelectasis, pulmonary mass, or hemoptysis with normal chest x-ray. One of the 22 patients (5%) with diffuse pulmonary nodules had active TB as did 3 of the 134 patients (2.24%) with pulmonary infiltrates. All 4 patients with NTM had pulmonary infiltrates. The use of a cost-effective diagnostic strategy in our series, wherein testing would have been ruled out for patients without a clinical suspicion of TB and radiologic findings of a pulmonary mass (n = 107, 35.6%), would have saved the system US $5350. CONCLUSION: The findings highlight the importance of an effective strategy for routine TB cultures during bronchoscopy in patients from nonendemic areas in whom TB is not suspected, especially those with pulmonary mass.     

伴胸部受累的淋巴瘤25例临床分析

目的 分析伴胸部受累的淋巴瘤的临床特点与诊断方法,以提高其诊断率.方法 回顾性分析2000-2007年北京大学第三医院确诊的有胸肺病变的淋巴瘤患者25例,收集患者确诊前的症状、体征、实验室检查结果、影像学资料、确诊方法和病理诊断.结果 25例患者中位年龄46岁,发热(13例)、6个月内体重减轻10%以上(11例)、咳嗽(10例)、气短(9例)、浅表淋巴结无痛性肿大(16例)是最常见的临床表现.72.7%的患者ESR增快;81%的患者血清乳酸脱氢酶(LDH)升高.25例患者中纵隔肺门淋巴结肿大者16例;影像学显示肺受累15例,包括斑片或实变表现、团块、多发结节、弥漫磨玻璃影、粟粒样病变;另外胸腔积液10例,心包积液4例,胸壁肿物2例;上述表现中有2种以上同时存在的患者18例.胸膜受累患者的胸腔积液外观呈黄色浑浊、血性或乳糜性,黏蛋白试验均阳性,比重1.031,白细胞6.72×10~9/L,淋巴细胞86%,中性粒细胞14%,蛋白31.4g/L,LDH 296 U/L,腺苷脱氨酶(ADA)67.4 U/L.外科手术活检确诊16例,其中浅表淋巴结活检确诊12例;超声或CT引导穿刺活检确诊5例;骨髓穿刺确诊1例;胸腔镜胸膜活检和纵隔镜纵隔肿物活检确诊各1例;经支气管镜黏膜活检确诊1例,而接受支气管镜气道黏膜活检和(或)经支气管肺活检(TBLB)确诊共8例.病理诊断除1例霍奇金淋巴瘤外,其余24例均为非霍奇金淋巴瘤.结论 伴胸部受累的淋巴瘤患者临床表现缺乏特异性,同时存在浅表或纵隔淋巴结肿大较为多见,血清学检查、胸腔积液性质和影像学检查亦有一定特点.浅表淋巴结手术活检是确诊淋巴瘤简便易行的方法;微创活检方法如超声或CT引导下浅表肿物、胸膜、肺、肝、脾、深部淋巴结活检及胸腔镜和纵隔镜胸膜、肺、纵隔病变活检亦具有较好的诊断价值,而经支气管镜获取气道黏膜和肺组织确诊率低.