早期原发性支气管癌10例误诊分析

近年来 ,原发性支气管癌 (肺癌 )发病率呈上升趋势 ,有资料表明 ,约 6 5 %的患者发现时已属晚期[1] ,失去了手术根治的机会。由于肺癌早期症状不典型 ,容易误诊 ,故早期诊断成为提高生存率的主要因素。 1998～2 0 0 1年我院共收治 186例肺癌 ,Ⅰ期肺癌 16例 ,其中有10例误诊 ,误诊率 6 2 5 %。现分析误诊原因如下。1　临床资料1 1　一般资料　本组男 6例 ,女 4例 ;年龄 2 7～ 74岁 ;病程 3个月～ 2年。 8例有吸烟史。1 2　症状与体征　少量咯血 2例 ,咳嗽、血痰或伴脓痰、发热 8例 ,盗汗 2例。1 3　影像学检查　 10例X线胸片均未发现块影 …     

原发性支气管癌

１９８４年５月～１９９９年５月,我们共收治６８６例原发性支气管癌（肺癌）,４４例早期无呼吸道症状,其中３２例误诊为其他疾病,误诊率７３％。现将其临床资料分析如下。１临床资料１．１一般资料本组３２例中,男２６例,女６例;年龄最小３０岁,最大７６岁,平均５４．５岁。１．２临床表现本组３２例根据其首发症状分以下３类;①无任何症状４例。均系正常人群在健康体检时,行胸部Ｘ线检查发现肺部有不规则团块阴影,经手术切除、病理学检查诊断为鳞癌３例,腺癌１例。②以肺外表现为首发症状的１２例,其中男性乳腺增生症４例,…     

支气管粘液表皮样癌误诊1例

1　临床资料患者女性 ,4 1岁 ,因反复咳嗽、咳痰 10月余入院。患者于 2 0 0 0年 9月出现咳嗽、咳痰 ,劳累及体位改变时加重 ,痰为白粘痰 ,量多 ,易咳出 ,伴发热(体温最高达 39.8℃ )、胸闷、气促、盗汗 ,无心悸、胸痛、咯血等不适。就诊于当地医院 ,先后按“肺炎”、“肺结核”给予抗感染及抗结核治疗 ,症状减轻。2 0 0 1年 3月复查胸片提示病灶增大 ,症状进行性加重。于 2 0 0 1年 7月 2 4日转我科。患病以来食欲、精神、睡眠、体力欠佳 ,体重减轻约 10公斤。既往有“糖尿病”史 3年。查体 :浅表淋巴结未及肿大 ,气管居中 ,双下肺语颤稍增…     

原发性支气管癌48例X线检查漏、误诊分析

Ｘ线检查仍是诊断原发性支气管癌 (肺癌 )的基本手段。由于肺癌Ｘ线表现多种多样 ,病变早期缺乏特征性 ,易漏诊或误诊 ,文献报道漏误诊率达 2 0 %～50 % [1] 。本文收集我院 1993年 1月～ 1999年 1月临床资料完整的肺癌 4 8例 ,就其Ｘ线检查漏、误诊的原因 ,作一回顾性分析。1　临床资料1 1　一般资料　本组男 3 6例 ,女 12例 ;年龄 2 7～ 93岁 ,其中 50岁以上 4 6例 ( 92 % )。首发症状 :咳嗽 3 6例 ,咳血痰 17例 ,胸痛 16例 ,声嘶 2例 ,乳房发育与额部皮下结节各 1例 ,无症状 5例。1 2　诊断依据　手术后病理诊断 2 0例 ,痰脱落细胞学检查…     

原发性输尿管癌的影像学诊断

1995年2月-2003年5月．我院收治原发性输尿管癌16倒，术前确诊12例，误诊4例，现报告如下。     

肺炎浸润型细支气管肺泡癌CT误诊分析

在胸部Ｘ线片或ＣＴ片上 ,肿块型肺癌已为大家所熟知 ,但表现为片状实变形态的细支气管肺泡癌 (ＢＡＣ)却容易与肺炎或结核相混淆。笔者收集ＢＡＣ 9例 ,术前ＣＴ均误诊为肺炎或肺结核 ,后经手术或经皮细针穿刺病理证实为ＢＡＣ。现就其ＣＴ表现进行分析 ,以提高对ＢＡＣ的认识 ,减少影像学误诊。1　临床资料1 1　一般资料　本组 9例中 ,女 6例 ,男 3例 ;年龄 2 3～ 5 5岁。主要症状为咳嗽、胸痛 ,出现症状时间 2～ 18个月 ;其中 2例咳多量粘液痰 ,听诊闻及干湿性罗音 ;7例实验室检查白细胞计数升高。 9例均经抗感染或抗结核治疗 ,效果不佳…     

原发性气管腺样囊性癌的影像诊断

目的 提高气管腺样囊性癌(Acc)的诊断水平。方法 对20例经病理证实的气管腺样囊性癌的临床与影像表现进行回顾性分析。结果 Acc好发于气管后侧壁，年龄偏低，生长缓慢，少见淋巴转移。于管壁及腔内外呈结节状或弥漫浸润性生长。气管体层、cT、螺旋CT重建及MRI均可显示。结论 与其他气管肿瘤一样较易延误诊断，但只要提高警惕，加强对本病的认识，紧密结合临床，多数患者是能作出诊断的。     

胸膜肿瘤误诊为原发性支气管癌

【例 1】　女 ,3 3岁。因咳嗽、咳痰 15天入院。无胸痛、咯血、发热等。查体 :体温 3 6 8℃ ,呼吸 17 min ,血压 112 75mmHg。左下肺呼吸音减弱。X线胸片及CT提示左下肺块影。诊断为左下肺周围型原发性支气管癌 (肺癌 )。剖胸探查见肿瘤位于左下肋胸膜 ,大小约 6cm× 5cm× 6cm ,质软 ,包膜完整 ,与肺组织无粘连 ,基底部较宽 ,完整切除肿瘤。病理诊断 :左侧局限型胸膜间皮瘤。【例 2】　女 ,44岁。因右背部针刺样疼痛 1个月伴轻度胸闷入院。疼痛向右前胸壁放射 ,无发热、咳嗽、咯血等。查体 :体温3 6 5℃ ,呼吸 18 min ,血压 12 5 90mmH…     

Alveolar cell carcinoma: diagnostic pitfalls in evaluating the chest roentgenogram

We have reported two cases of biopsy-proven alveolar cell carcinoma, both initially thought to be pulmonary edema. The purpose of this report is to stress the variations of the roentgenographic pattern in alveolar cell carcinoma and to suggest that fiberoptic bronchoscopy with biopsy should be considered when a pattern thought to be that of pulmonary edema does not resolve with appropriate therapy.     

Early localization of bronchogenic carcinoma

The performance of a fluorescence imaging device was compared with conventional white-light bronchoscopy in 100 patients with lung cancer, 46 patients with resected stage I non-small cell lung cancer, 10 patients with head and neck cancer, and 67 volunteers who had smoked at least 1 pack of cigarettes per day for 25 years or more. Using differences in tissue autofluorescence between premalignant, malignant, and normal tissues, fluorescence bronchoscopy was found to detect significantly more areas with moderate/severe dysplasia or carcinoma in situ than conventional white-light bronchoscopy with a similar specificity. Multiple foci of dysplasia or cancer were found in 13-24% of these individuals. Fluorescence bronchoscopy may be an important adjunct to conventional bronchoscopic examination to improve our ability to detect and localize premalignant and early lung cancer lesions.     

Facial pain as the presenting symptom of lung carcinoma with normal chest radiograph

Facial pain is a rare presenting symptom of nonmetastatic lung carcinoma. Referred pain from tumor invasion and compression of the vagus nerve was the presumed cause in the 31 cases published to date. We report 2 additional cases having an unusual clinical feature, namely, both had radiographic evidence of malignancy absent on initial chest films. Severe facial pain in both cases was explained by pulmonary carcinoma detected only through further investigations. From these cases follows the notable conclusion that referred facial pain of malignant origin can occasionally precede the appearance of neoplasm on routine chest films. It is therefore important for physicians to be familiar with the clinical features of this syndrome in order to choose appropriate further diagnostic testing in patients who may be at risk.     

电子支气管镜诊断X射线胸片正常咯血患者的价值

目的评价电子支气管镜对X射线胸片正常咯血患者的诊断价值。方法对45例X射线胸片正常的40岁以下资料完整的咯血患者的电子支气管镜检查资料进行分析。结果32例确诊（71．1％），其中炎症25例（55．6％），结核3例（6．7％），支气管扩张2例（4．4％），肺癌2例（4．4％），未确诊13例（28．8％）。结论电子支气管镜对胸片正常的40岁以下咯血患者的诊断，特别是发现早期肺癌患者有重要临床实用价值；     

Resectable bronchogenic carcinoma presenting with hypercalcemia: tumor-associated granulomatous reaction and probable production of 1,25-dihydroxyvitamin D

A patient with hypercalcemia, increased levels of 1,25-dihydroxyvitamin D, and a resectable squamous cell bronchogenic carcinoma surrounded by numerous non-caseating epithelioid granulomas, achieved normocalcemia, decreased levels of 1,25-dihydroxyvitamin D, and no evidence of tumor recurrence at 30 months following complete resection of his tumor. We suggest that an excess production of 1,25-dihydroxyvitamin D, through the granulomatous reaction around the tumor, was the mechanism of hypercalcemia. To our knowledge, no such mechanism of hypercalcemia has been previously reported with bronchogenic carcinoma. Furthermore, a review of the literature reveals that in cases of bronchogenic carcinoma, hypercalcemia is almost always associated with large and unresectable tumors, with a median survival after the discovery of hypercalcemia of only one month. This case, then, is unique because it describes an unusual mechanism of hypercalcemia with bronchogenic carcinoma and it emphasizes the rare occurrence of the potentially curable patient presenting with bronchogenic carcinoma complicated by hypercalcemia.