X线透视下TBLB在肺部弥漫性病变中的诊断价值

目的探讨X线透视下经支气管镜肺活检（transbronchial lung biopsy,TBLB）在肺部弥漫性病变中的诊断价值。方法对27例肺部弥漫性病变患者在X线透视下TBLB,对临床资料及病理结果进行分析。结果 27例患者中有18例通过病理获得确诊。结论 X线透视下TBLB在肺部弥漫性病变诊断中是一种安全、有效、易于接受的方法。     

经支气管镜肺活检对弥漫性肺间质性疾病的诊断价值

目的探讨经纤维支气管镜肺活检（TBLB）对弥漫性肺间质性疾病的诊断价值。方法51例弥漫性肺问质性疾病患者,在无X线电视透视下行TBLB,对临床资料及病理诊断结果进行分析。结果51例弥漫性肺疾病中有16例明确了病因学诊断,确诊率达31．4％。临床诊断病例共28例,诊断率达54．9％,未能明确诊断7例（13．7％）。结论纤维支气管镜肺活检对弥漫性肺间质性疾病的诊断是一种可靠、安全、简便、经济的方法,特别是在弥漫性肺疾病诊断中除外结节病、肿瘤和某些特殊类型的感染有重要价值。     

A case of pulmonary squamous cell carcinoma coexisting with pulmonary actinomycosis]

A 71-year-old man was referred to our hospital complaining of cough. Chest radiography revealed a mass opacity in the right upper lung field. A transbronchial biopsy specimen revealed non-specific inflammatory changes. Percutaneous lung aspiration biopsy under ultrasound guidance demonstrated gram-positive rods, suggesting actinomyces. On the diagnosis of pulmonary actinomycosis, the patient was treated with penicillin-G and his symptoms were relieved. In a three-month follow-up, the mass shadow in the right upper lung field was found to have increased in size. Squamous cell lung cancer was diagnosed on the basis of repeated transbronchial tumor biopsies, and right upper lobectomy was performed. Most cases of pulmonary actinomycosis have been diagnosed from post-surgical tumor specimens taken on suspicion of the presence of lung cancer. However, the lung cancer in this case was difficult to diagnose because the lung cancer was co-existent with pulmonary actinomycosis.     

A case of pulmonary eosinophilic granuloma arising rapidly 30 years after the start of smoking and remitting spontaneously without smoking cessation]

A case of pulmonary eosinophilic granuloma which arose rapidly after 30 years of smoking and remitted spontaneously without smoking cessation is reported. The patient was a 54-year-old man complaining of a dry cough who had been smoking 30 cigarettes a day for 30 years. Chest roentgenography showed multiple nodular shadows and cystic lesions in the upper and middle fields of both lungs. Chest computed tomography revealed multiple small cysts and small nodular lesions, mainly in both upper lung fields. CT findings strongly suggested pulmonary eosinophilic granuloma. A transbronchial lung biopsy (TBLB) was performed and 4 specimens were obtained, of which 3 showed granulomatous lesions with eosinophils and histiocytes. Furthermore, the granulomatous lesions were positive for S-100 protein staining. The symptoms and radiographic findings improved markedly within about 6 months after the onset of symptoms without treatment. Many cases of this disease were diagnosed in the past by open lung biopsy, but the number of cases diagnosed by TBLB is now increasing. The effectiveness of open lung biopsy has been emphasized in the diagnosis of pulmonary eosinophilic granuloma, but TBLB is also useful for diagnosis, especially in the active or early stage of the disease.     

经支气管镜肺活检对弥漫性肺间质性疾病的诊断价值及文献复习

目的探讨经支气管镜肺活检（TBLB）对弥漫性肺间质性疾病（DILD）的诊断价值。方法对71例DILD患者在无X线电视透视下行TBLB,并对临床资料及病理诊断结果进行回顾性分析。结果 71例DILD中22例明确诊断,确诊率达31.0%,确诊的疾病种类主要有肺结核7例（31.8%）,普通型间质性肺炎5例（22.7%）,肺泡细胞癌4例（18.2%）,转移性肺癌2例（9.1%）,肺真菌病1例（4.5%）结节病1例（4.5%）,肺泡微石症1例（4.5%）,隐原性机化性肺炎1例（4.5%）;临床诊断病例共31例,诊断率达43.7%,其中特发性肺纤维化15例（48.4%）,结缔组织病相关肺疾病11例,弥漫性泛细支气管炎2例（6.5%）,癌性淋巴管炎2例（6.5%）,炎性假瘤1例（3.2%）;未能明确诊断18例（25.4%）。结论 TBLB对DILD的诊断是一种安全、简便、有效的方法,特别是在除外结节病、肿瘤和某些特殊类型的感染（结核）有重要价值。肺间质性疾病的病理诊断特别是病理分型需要较大的组织,必要时可行胸腔镜（VATS）肺活检或开胸肺活检,以提高对DILD的诊断水平。     

A case of pulmonary eosinophilic granuloma diagnosed by TBLB]

A case of pulmonary eosinophilic granuloma which was diagnosed by TBLB was presented. A 24-year-old male was admitted complaining of cough and fever of unknown etiology. He had a history of fever which had disappeared spontaneously 9 months previously. Laboratory examinations including blood gas analysis and pulmonary function tests showed no significant abnormalities. Chest roentgenogram showed faint linear opacities. Computed tomography revealed multiple small cysts and small nodular lesions mainly in the upper lung field. CT findings were strongly suggested pulmonary eosinophilic granuloma. TBLB was performed and 6 specimens were obtained, of which 4 showed granulomatous lesions consisting of histiocytosis X cell and inflammatory cells with infiltration of eosinophils. Furthermore, granulomatous lesions were positive for S-100 protein staining. The effectiveness of open lung biopsy has been emphasized in the diagnosis of pulmonary eosinophilic granuloma, however, TBLB is also useful for diagnosis, especially in the active or early stage of this disease.     

经纤维支气管镜肺活检对弥漫性间质性肺疾病的诊断价值

目的探讨经纤维支气管镜肺活检（TBLB）对弥漫性间质性肺疾病（D ILD）的诊断价值。方法报道168例D ILD患者,其中行TBLB病理检查确诊45例（26.79%）,分析患者性别、病理诊断构成比及误诊情况等。结果 45例患者中,误诊为非特异性肺炎8例,肺结核6例,肺癌5例,肺淋巴瘤4例,肺动脉高压3例,气道中心纤维化2例;女性患者明显多于男性（27 vs 18,P〈0.01）。D ILD患者中特发性间质性肺炎最多（32例）,其次是结缔组织病相关D ILD（8例）、结节病（5例）。结论 TBLB是诊断D ILD的有效手段,对D ILD的鉴别诊断和分类诊断有重要意义。     

Primary gastric actinomycosis: A case report.

Gastric actinomycosis is an extremely rare disease. To date, about 20 cases have been reported in the literature. In most cases, diagnosis was made by histopathologic evaluation of an operative specimen. We report here a 68-year-old man with primary gastric actinomycosis who was admitted to the hospital with upper gastrointestinal bleeding and diagnosed as actinomycosis by microscopic examination of biopsy specimens obtained by endoscopy. This case is reported because of the rarity of endoscopically diagnosed primary gastric actinomycosis.     

Asymptomatic pulmonary actinomycosis diagnosed by transbronchial lung biopsy (TBLB)]

A 65-year-old asymptomatic man was admitted to our hospital because a chest abnormal shadow had been pointed out on a medical examination. Our investigation resulted that the consolidation in the left lung had been initially documented in 2002, and had been expanding every year. Bronchofiberscopy showed flare, swelling and stenosis of the left B8, B9 and B10. Because the biopsy specimen from the B9 showed a mass of bacteria and surrounding granulation tissue, pulmonary actinomycosis was diagnosed. Pulmonary actinomycosis should be considered in the differential diagnosis of abnormal chest shadows regardless of the absence of symptoms.     

不同肺活检方法诊断肺癌的价值比较

目的对比分析3种肺活检不同方法在疑似肺癌中诊断中的价值和利弊。方法门诊及住院患者经肺部X线照片和CT检查结果诊断为肺部块影而疑似肺癌的患者78例,分别应用经支气管镜肺活检(TBLB)、CT下经皮肺活检、外科肺活检进行检查,对病理的及临床资料进行对比分析。结果报道78例疑似肺癌患者,诊断率为46.15%。TBLB术确诊率为39.5%,外科肺活检术确诊率为91.7%。CT下经皮肺活检术确诊率为35.7%。而Ⅰ～ⅢA检出率为34.6%。并发症发生率依次为外科肺活检、CT引导下肺活检、TBLB。结论 TBLB是诊断肺癌的首选确诊手段,其优点为阳性率高、费用低、并发症小,有利于肺癌的鉴别诊断和分期,而位于周边型肺癌应首选CT下经皮肺活检,对于其他未能确诊且疑难肺部肿块者宜选用外科肺活检。     

经支气管镜肺活检对弥漫性肺实质疾病的诊断价值

目的 评价经支气管镜肺活检(TBLB)在弥漫性肺实质病变诊断中的作用.方法 回顾性分析2001年1月至2006年10月在北京协和医院住院、经TBLB检查且具有完整临床资料的肺部弥漫性疾病患者416例,男157例,女259例,平均年龄(42.6±18.9)岁.结果 416例中124例(29.8%)经支气管镜肺活检确诊,其中结节病52例(41.9%),闭塞型细支气管炎伴机化性肺炎(BOOP/OP)28例(22.6%),肺泡蛋白沉积症(PAP)19例(15.3%),肺部肿瘤12例(9.7%),肺血管炎5例(4.0%),肺结核3例(2.4%),肺孢子菌肺炎、曲霉肺炎、嗜酸细胞肺炎、淋巴管肌瘤病(LAM)及肺淀粉样变各1例.经支气管镜肺活检未确定诊断的患者中104例进行了开胸或胸腔镜活检,98例确诊,其中非特异性间质性肺炎37例(37.7%),寻常型间质性肺炎18例(18.4%),结节病11例(11.2%),BOOP/OP 6例(6.1%),肿瘤5例(5.1%),外源性过敏性肺泡炎4例(4.1%),曲霉肺炎、PAP、淋巴细胞间质性肺炎、肺动脉高压及LAM各2例(各占2.0%),结核、肺血管炎、组织细胞增生症X、呼吸细支气管炎伴间质性肺炎、脱屑性间质性肺炎、弥漫性泛细支气管炎、气道中心性纤维化各1例(各占1.0%).结论 TBLB可对约30%的肺部弥漫性肺疾病确诊,可作为开胸之前的常规筛查手段.     

Pulmonary actinomycosis presenting as a mass lesion on chest X-ray film]

A 61-year-old man presented with fever, productive cough, and occasional blood-streaked sputum. Chest X-ray films disclosed a poorly defined mass in the right middle lung field. A transbronchial lung biopsy specimen showed epithelial changes indicative of lung cancer, and a right lower lobectomy was performed. Because the resected specimen contained a cavity filled with colonies of actinomycetes, pulmonary actinomycosis was diagnosed. The cavity was surrounded by inflammatory infiltrations and fibrosis with occasional atypical epithelial changes suggestive of benign hyperplasia. Although pulmonary actinomycosis is uncommon today, it deserves attention because of the potential difficulty in differentially diagnosing it from lung cancer.     

Pulmonary tumor thrombotic microangiopathy associated with esophageal squamous cell carcinoma

Pulmonary tumor thrombotic microangiopathy (PTTM) is an uncommon cancer-related complication that has been most frequently reported to be associated with adenocarcinoma. We present a case of PTTM which developed in a 60-year-old man with esophageal carcinoma. One year after definitive treatment of the tumor, he developed pulmonary hypertension. Transbronchial lung biopsy (TBLB) specimens showed fibrocellular intimal proliferation and luminal stenosis of the small pulmonary vessels, which contained squamous cell carcinoma cells. Thus, PTTM associated with esophageal carcinoma was diagnosed. This is the first reported case of PTTM associated with esophageal squamous cell carcinoma. TBLB seemed to be useful for obtaining a definitive diagnosis.     

A case of intravascular lymphomatosis with no abnormal findings on chest computed tomography and with diffuse pulmonary uptake of 67Ga on scintigraphy]

A 45-year-old man was admitted to our hospital with high-grade fever uncontrolled by antipyretic drugs, and elevation of the serum LDH and sIL-2R levels, and decrease of diffusing capacity for carbon monoxide. Chest computed tomography (CT) showed no abnormal findings but 67Ga scintigraphy revealed diffuse pulmonary uptake. He was given a diagnosis of intravascular lymphomatosis (IVL) based on transbronchial lung biopsy (TBLB) and immunohistochemical analysis. The prognosis of IVL is generally bad, because antemortem diagnosis is difficult. In this case early TBLB enabled satisfactory curative effect of IVL.     

A case of organizing pneumonia associated with myelodysplastic syndrome (MDS)]

A 53-year-old man was referred to our hospital because of atypical cells in the peripheral blood. Myelodysplastic syndrome (MDS) was diagnosed by bone marrow examination. Since he had a continuous dry cough, high fever, and air space consolidation in both lower lung fields, he was admitted to our hospital for further examination. Infectious disease, autoimmune disease, vasculitis and neoplasms were excluded. A transbronchial lung biopsy (TBLB) was performed at the right S(10), and histopathological examination of the specimen thus obtained suggested an organizing pneumonia (OP) associated with MDS. Oral prednisolone 30 mg was administered daily, and the symptoms and radiographic findings immediately improved. Accurate diagnosis of the pulmonary involvement associated with patients with MDS is sometimes difficult to make. However, either BOOP or OP should be considered as a differential diagnosis in case the patient presents with continuous coughing, high fever, and air space consolidation. Interventional examinations such as TBLB should be conducted to make a histological diagnosis if the patient's condition allows it.     

肺活检诊断肺部弥漫性病变

为了鉴别17例肺部弥漫性病变的诊断,应用局限性开胸作肺组织活检得到确诊。有6例结节病;5例恶性肿瘤肺转移;3例结核;2例特发性肺纤维化和1例肺泡蛋白沉着症。本文讨论手术方式和指征。作者认为在包括TBLB在内各种常规检查失败之后,应作局限性开胸肺活检,这是诊断肺部弥漫性病变的安全可靠的方法。     

Endobronchial actinomycosis simulating bronchogenic carcinoma. Diagnosis by bronchial biopsy

Five cases of actinomycosis of the main bronchi or trachea which were suggestive clinically of bronchogenic carcinoma are described. In four patients the correct diagnosis was made by a bronchial biopsy or wash, or both. Three of them recovered following antibiotic treatment, and one died a few days after bronchoscopy. In one case the Actinomyces were found in the bronchial wash retrospectively following diagnosis of pulmonary actinomycosis in the lobectomy specimen. A concomitant endobronchial lipoma was found in one of the patients. The diagnosis of pulmonary actinomycosis by bronchial biopsy may save the patient major surgical intervention.     

全肺灌洗治疗肺泡蛋白沉积症6例的临床分析

目的：总结肺泡蛋白沉积症（PAP）的临床特征,评价大容量全肺灌洗治疗的临床疗效和安全性。方法：回顾性分析6例PAP患者临床资料。结果：6例患者均行支气管镜肺活检（TBLB）和支气管肺泡灌洗液（BALF）镜检,PAS染色阳性。1例肺活检病理检查符合肺泡蛋白沉积症。6例患者行全肺灌洗治疗,治疗后临床症状、胸部影像学、肺功能、动脉血气均明显改善。结论：胸部CT双肺弥漫性病变呈“地图样”或“铺路石样”特征性改变应警惕本病的可能,TBLB、BALF及肺活检病理检查可确诊PAP,大容量全肺灌洗治疗PAP安全有效。     

Spectrum and diagnosis of idiopathic pulmonary fibrosis

OBJECTIVE: To study the clinical profile of patients with idiopathic pulmonary fibrosis (IPF) and methods used for diagnosis. METHODS: Prospective analysis of symptoms, signs, radiology and lung biopsy of patients freshly diagnosed to have IPF over a 16-month period. RESULTS: During the study period, 76 patients (35 men) with a mean age of 50.6 +/- 11.9 years were diagnosed to have IPE Breathlessness (98.6%) and dry cough (92.1%) were the most common presenting symptoms. Transbronchial lung biopsy (TBLB) was performed in 38 (50%) patients. Histopathological examination revealed features consistent with IPF in 35 (92.1%) patients; two of the remaining three patients underwent open lung biopsy. Other patients were diagnosed based on clinical features and high resolution chest tomography (HRCT) findings. HRCT was performed in 69 (90.8%) patients; all had features suggestive of diffuse interstitial fibrosis. CONCLUSION: IPF is diagnosed more commonly now than in the past. Indian patients may be developing the disease a decade earlier than their counterparts in the West. TBLB and HRCT are useful in establishing diagnosis. IPF should be considered a distinct clinical entity rather than a diagnosis of exclusion.     

A case of pulmonary actinomycosis marked by diagnostic difficulty]

A 59-year-old man was admitted to our hospital for evaluation of an abnormal lung shadow. Chest X-ray and computed tomographic (CT) films showed a mass shadow in the left lower lobe. The shadow decreased in size after the administration of imipenem/cirastatin and clindamycine. Although a transbronchial lung biopsy failed to confirm the diagnosis, histologic examination of percutaneous aspiration biopsy specimens revealed sulfur granules. Actinomycosis was diagnosed but we did not rule out the possibility of coexistent carcinoma. A left lower lobectomy was performed, and the patient has been well without any complaints or recurrence of actinomycosis for 6 months after surgery. We concluded that pulmonary actinomycosis should be considered another candidate for the differential diagnosis of mass shadows from lung cancer.