成人支气管异物长期误诊1例并文献复习

目的 提高对成人支气管异物的认识和诊治水平,避免长期误诊、误治.方法 回顾我院收治的1例长期误诊支气管异物成年患者病历资料,并复习相关文献,探讨成人支气管异物在临床症状、胸部影像学及支气管镜下的不典型表现以及造成患者长期误诊、误治的原因.结果 成年患者,近4年反复咳嗽、咯痰、喘憋,影像学上有弥漫性磨玻璃影、多发支气管扩张及斑片影等多种表现,曾行支气管舒张试验阳性,严重时曾行气管插管,入我院后行支气管镜检查确诊为右中间段支气管异物,后长期随访患者临床表现、影像学及肺功能检查已治愈.结论 成年患者常无明确异物吸入史,临床症状不典型,影像学常无异物存在直接征象,容易造成临床误诊、误治,支气管镜对成人支气管异物的诊治有重要价值.     

慢性阻塞性肺病患者并发气胸误诊分析

1．1一般资料我院自1998年1月至2003年5月共收治慢性阻塞性肺病1920例．发生气胸36例．其中27例被误诊，误诊率高达75％。36例中男29例，女7例；年龄45～90岁，平均62．3岁。肺部基础疾病．慢性支气管炎4例．慢支气管炎并肺气肿15例．并发肺心病17例。     

气道侵袭性曲霉病1例并文献复习

目的 探讨气道侵袭性曲霉病临床表现、诊断及治疗方法.方法 结合我院收治的1例气道侵袭性曲霉病病例的临床资料及国内外文献报道进行综合分析.结果 患者女性,49岁,间断咳嗽、咯痰、发热1个月,胸部CT提示左下叶实变,在外院抗炎、抗结核治疗1个月,未见明显好转收入院.入院后行气管镜检查,活检提示曲霉菌感染,抗真菌及气管镜下反...     

COPD合并自发性气胸12例临床误诊分析

目的提高基层医院医护人员对COPD并发自发性气胸的诊断水平,以减少误诊率。方法回顾性总结我院2000年1月～2007年1月COPD并发自发性气胸病例,并分析误诊的原因。结果本组误诊12例,误诊为COPD急性发作、哮喘急性发作、肺性脑病、急性左心衰等。误诊时间4～48h。结论对出现病情变化的COPD患者应认真进行体检,常规行胸部X线检查。从而降低COPD并发自发性气胸的误诊、漏诊率。     

持续慢性呼吸症患儿应怀疑气道异物可能

目的探讨气道异物延误诊断的因素和长时留存气道异物的主要表现。方法回顾性研究自2004年6月~2008年9月在我院行气道异物取出术的患儿,选取异物留存超过30 d患儿作为研究对象行统计分析。结果从2004年6月~2008年9月我院共有1263例气道异物取出术,其中异物留存超过30 d的为107例（8.47%）,农村儿童86例（80.37%）,临床表现主要是反复发热（69例,占64.49%）、慢性咳嗽（62例,占57.94%）和喘鸣（44例,占41.12%）等。结论来自农村气道异物患儿,常因为影像学不典型和基层医生缺乏气道异物意识而误诊,临床表现为慢性呼吸症状和影像学炎症征象。     

支气管肺内异物误诊肺肿瘤1例

气管、支气管、肺内异物在临床上比较常见，诊断上一般不难，但长期存留肺内引起感染出现炎性肿块，极易误诊为占位性病变。笔者从事纤维支气管镜检查工作中，发现1例患者长期（超过6个月时间）误诊为右肺占位性病变。现报告如下。     

9例气胸内科胸腔镜检查并文献复习

目的探讨气胸患者治疗方案及减少或避免复发。方法回顾我院对9例气胸患者行内科胸腔镜检查。结果8例患者镜下发现肺表面有多个大小不等的肺大疱,壁薄光滑的气囊突起于肺表面,有的肺大疱在肺叶边缘或位于叶间裂,上下肺叶均波及。2例除了多发肺大疱外,还有部分肺组织与胸壁间有粘连带。1例患者肺表面未发现异常。结论内科胸腔镜发现气胸病灶客观、准确。在技术设备允许的条件下气胸病人都应尽早行内科胸腔镜检查。     

气道内异物所致金黄色葡萄球菌菌血症一例

患者,男,16岁.因＂全身肌痛伴发热1周＂,于2013年4月5日入院.患者入院前1周因长跑3000米后出现全身肌肉酸痛无力,自觉发热不适（体温不详）,无明显咳嗽、咳痰及呼吸困难等症状.于当地医院行胸部CT检查提示＂两肺多发渗出性病灶＂,给予头孢孟多抗感染及对症治疗,上述症状无缓解,为进一步治疗收住我院.患者既往体健,无手术及近期外伤史,无长期使用免疫抑制药物及抗生素史.体格检查：皮肤无黄疸及破损.双肺呼吸音粗,双下肺可闻及少许湿啰音.全身肌肉压痛,双下肢为甚,以左侧髂腰部明显.     

支气管异物误诊肺内感染17年1例

患者，男，22岁，6年前因咳嗽，咳黏稠脓性血丝痰，伴有臭味，在农村卫生院按“肺炎”治疗2周。近2年经常“感冒”伴咳嗽，咳脓痰，偶有血痰，经多家医院检查均按“肺炎”抗炎治疗，病情反复。近2周咳嗽加重，CT检查疑似肺结核来我院就诊，于2005年7月20日入院。入院后查体：一般状态好，无杵状指，浅表淋巴结无肿大，左胸下可闻及湿啰音。     

Left spontaneous pneumothorax presenting with ST-segment elevations: a case report and review of the literature

Common electrocardiogram (ECG) changes associated with left-sided pneumothorax include right axis deviation, reduced R-wave amplitude in precordial leads, QRS alterations (amplitude changes), and T-wave inversions. Few reports exist of ST-segment elevations or changes suggestive of acute myocardial infarction (AMI), and these involve older patients with tension pneumothorax and previous coronary heart disease. We report on a young man with no significant medical history, presenting with left-sided spontaneous pneumothorax and ECG changes that included ST-segment elevations and T-wave inversions in the precordial leads, reminiscent of AMI. All changes resolved after decompression of the pneumothorax. On the basis of the patient’s presenting symptoms, response to therapy, and our review of the literature, we propose a number of possible mechanisms explaining his electrocardiographic findings.     

A subglottic foreign body mimicking croup: A case report

Introduction:Foreign body (FB) aspiration is one of the causes of respiratory distress in infants is an extremely dangerous and potentially life-threatening event. The diagnosis of FB aspiration is difficult because the signs and symptoms vary according to the degree of airway blockage or location of the FB.Patient concerns:An 11-month-old female infant visited a hospital because of a sudden onset cough. She was relatively healthy without fever, rhinorrhea cyanosis, or poor feeding. On physical examination, auscultation revealed inspiratory stridor without wheezing and crackles.Diagnosis:Croup was suspected when considering the history, physical examination, and imaging. However, she did not respond to a 4-day course of treatment for croup. Flexible laryngoscopic examination was performed, and we identified a thin, flat, and sharp FB embedded in the subglottic region.Interventions:Emergency surgery was performed to remove the FB. Short-term intravenous corticosteroids and antibiotics were used to prevent laryngeal swelling and aspiration pneumonia.Outcomes:One week after the procedure, the laryngeal mucosa had completely healed.Conclusion:FB aspiration should be considered in an infant with an impression of croup. In particular, if there is no response to medical or conservative treatment for croup, further evaluation is needed.     

Hepatic abscess induced by foreign body： Case report and literature review

Hepatic abscess due to perforation of the gastrointestinal tract caused by ingested foreign bodies is uncommon. Pre-operative diagnosis is difficult as patients are often unaware of the foreign body ingestion and symptoms and imagiology are usually non-specific. The authors report a case of 62-year-old woman who was admitted with fever and abdominal pain. Further investigation revealed hepatic abscess, without resolution despite antibiotic therapy. A liver abscess resulting from perforation and intra-hepatic migration of a bone coming from the pilorum was diagnosed by surgery. The literature concerning foreign body-induced perforation of the gastrointestinal tract complicated by liver abscess is reviewed.     

Electric wire as a urethral foreign body: A case report

Rationale:Most self-insertion of urethral foreign bodies is the result of exotic impulses, psychometric problems, sexual curiosity, or sexual practice while intoxicated. Ultrasound has been proven to be an effective tool for determining the presence, location, and characteristics of the urethral foreign body.Patient concerns:A 48-year-old man presented with a mass in the urethra for 2 years. Physical examination suggested swelling and ulcer in the scrotum. The white blood cell count was elevated (12.60 × 10⁹/L). Urinalysis showed an increased white cell count (484.60/μL) and urine occult blood (±).Diagnosis:Ultrasound examination of the genitourinary system identified an 8.3 cm linear hyperechoic object and hyperechoic spots in the urethra. Computed tomography revealed an extremely hyperdense lesion in the penis. Intraoperative findings showed electric wire bending and winding surrounded by fibrous tissues with urethral rupture.Interventions:The patient was treated with urethrotomy as the endoscopic treatment failed. and the electric wire was removed successfully.Outcomes:The patient was followed up for 45 days without discomfort. Ultrasound examination of the genitourinary system suggested that the wound was almost healed, but with a small urethral effusion, with a maximum depth of approximately 1.9 mm.Lessons:A foreign body was inserted into the patient''s urethra for 2 years without any medical treatment. Urethral perforation was found during surgery. In such cases, ultrasound examination can determine the location, shape, and size of the urethral foreign body and play an important role in the diagnosis of foreign bodies.     

The tracheobronchial foreign body in welder without the history of allotriophagy and foreign body aspiration

The typical chest computed tomography (CT) finding of the arc welders is ill‐defined micronodules diffusely distributed in the lung. We report a rare case of tracheobronchial foreign body in welder without the history of allotriophagy and foreign body aspiration. We used the CT and mineralogical analysis in diagnosis and the flexible fiberoptic bronchoscope in therapy. The CT showed bronchiectasis with pulmonary infiltration of the right lower lobe and high‐density shadow in the basal bronchus of the right lower lobe. The foreign bodies were removed by a fibreoptic bronchoscope. Semiquantitative chemical analyses showed that the constituent of foreign body was similar to the dregs which were collected in the same garage. This is an unusual case of the welding‐related respiratory diseases, which is different from Welder's siderosis and broncholith.     

以咳血丝痰及反复气胸为主要表现的肺上皮样血管内皮瘤1例并文献复习

目的 总结肺上皮样血管内皮瘤的特征,以提高临床医师对该病的认识.方法 通过对1例肺上皮样血管内皮瘤病例的临床、影像学及病理分析,并复习肺上皮样血管内皮瘤的相关文献,从而总结其特征.结果 首次报道以双肺反复出现气胸为临床表现及双肺逐步出现多个小囊状病灶为影像学特点的肺上皮样血管内皮瘤.结论 对于咳血丝痰、双肺反复出现气胸、影像学表现为双肺多个小结节、散在渗出病变及双肺逐步出现多个小囊状病灶的患者需考虑肺上皮样血管内皮瘤,最终确诊有赖于组织病理学及免疫组化检查.     

Spontaneous pneumothorax and Recklinghausen's disease: a case report

The Von Recklinghausen disease is a genetic hereditary neurofibromatosis. It causes neurofibroma, axillary and inguinal lentigines, and café-au-lait spots in the skin. It may affect the lung in 5 to 20% of cases, causing neurofibroma, infiltrative and cystic lesions, emphysematous or bubble injury leading to a chronic respiratory failure. The risk of pneumothorax in theses cases seems higher. Few reviews reported the pulmonary manifestations in the Recklinghausen disease and specially the pneumothorax as a complication while the direct relation between this neurofibromatosis and the lung disease is not clearly established yet. We report a case report of spontaneous pneumothorax with slow evolution complicating the course of a patient with Recklinghausen disease.     

Mediastinal hydatid cyst rupturing into the pleural cavity associated with pneumothorax: Case report and review of the literature

Hydatid disease remains a serious health problem in Mediterranean countries. Living in a rural area is an important risk factor for the disease. Hydatid cysts are usually located in the liver, lungs and brain. Mediastinal hydatid disease is very rare and has been noted only anecdotally in the literature. The present article reports a case of a mediastinal hydatid cyst rupturing into the pleural cavity, which was associated with pneumothorax of the same side. The patient’s previous chest x-rays (posteroanterior and left lateral views) showed a well-defined mediastinal mass on the left side, and contrast-enhanced computed tomography of the thorax (taken a few days after the chest x-ray) showed multiple round-to-oval soft tissue opacities with partial collapse of the left lung. An indirect hemagglutination test for echinococcus was positive. Even after two weeks of intercostal tube drainage, the patient’s condition did not improve. During thoracotomy, multiple daughter cysts were found in the pleural cavity, and the diagnosis of a hydatid cyst was confirmed after histopathological examination.