~(67)镓显像在肺结节病的显像分析及临床应用

目的:探讨 67镓检查在临床中对肺部结节病诊断的价值.方法:回顾性分析疑为结节病的72例患者(66例结节病, 6例非结节病) 67镓显像资料,并对肺部X线、CT检查和病理检查结果等临床资料进行分析.结果: 66例结节病患者中, 67镓检查诊断准确性为83.3%(55/66), X线、 CT为78.8%(52/66),两者无显著性差异(P=0.656 8).临床诊断为结节病的12例患者,曾行病理检查无法明确诊断,行 67镓检查的诊断准确性(91.7%, 11/12)明显高于X线或CT检查诊断的准确性(33.3%, 4/12), P=0.011 4. 4例病理诊断不能与增殖型结核鉴别,X线或CT检查不能明确诊断, 3例 67镓检查明确诊断结节病, 1例 67镓检查未发现有典型的结节病改变,最后诊断为肺结核.结论:67镓检查对难以明确诊断的肺结节病有一定的诊断价值.     

以双肺弥漫病变为表现的肺内结节病1例报告

结节病是一种病因不明以非干酪样肉芽肿为病理特征的多脏器受累的疾病,诊断包括临床和影像学表现,确诊依赖病理学检查。但结节病在我国发病率低,临床和影像表现可无特异性,经常遇到病理取材受限,并且随着研究进展,非干酪样肉芽肿即为结节病观点受到质疑等,使结节病容易误诊和漏诊。因此结节病的诊断仍是个难题。本文对我院收治的     

28例胸内结节病临床分析

目的:了解胸内结节病的临床特点、影像学和实验室检查结果,提高胸内结节病的诊断。方法:回顾性分析病理明确诊断胸内结节病28例的临床表现,影像学特点,辅助检查和病理诊断。结果:胸内结节病临床表现缺乏特异性,发病女性多于男性,中年为高峰,影像学表现分别为双肺门淋巴结肿大,纵隔淋巴结肿大,单侧肺门淋巴结肿大,肺内表现则多样化,斑片状、间质性、条索状、小结节影、胸腔积液及胸膜肥厚,查血管紧张素转换酶(ACE),尿钙,血沉,肺功能等,ACE(19/28)、尿钙(23/28)、ESR升高(18/28),PPD试验阴性(20/28)、通气储量百分比中度不足(15/28)。行纤支镜检查、纵隔镜、开胸肺活检等明确诊断,病理表现为:非干酪样肉芽肿。结论:胸内结节病,临床表现不典型,易误诊,诊断需结合影像学化验检查和病理明确诊断。     

胸部结节病的CT诊断

结节病是一种常见的全身性疾病,以胸部最常受累,约占90%以上,本病病因不清楚,诊断主要根据影像学表现及病理检查,但因其表现常无特异性,临床易误诊。笔者收集近年来接诊的结节病及其误诊病例,分析结节病影像学诊断中所遇到的问题。1临床资料1999-2005年接诊的结节病患者及其误诊病例共22例,男6例、女16例;年龄38~60岁,平均52.6岁。临床表现主要有咳嗽、气短、胸痛、发热、痰中带血。22例中明确诊断为结节病者14例,误诊8例,其中4例诊断为肺癌并纵隔淋巴结转移、2例诊断为肺炎、1例诊断为肺结核、1例诊断为正常。22例患者均行CT检查,CT表现…     

结节病25例临床分析

结节病是一种原因不明的多系统非干酪坏死性肉芽肿性疾病，以肺和淋巴结病变为最常见，其次是皮肤、心脏、眼和神经系统等。由于结节病临床表现可不典型，易造成漏诊或误诊。为提高对结节病的认识和诊断率，现对我院经病理诊断明确的结节病患者的临床资料作回顾性分析如下。     

10例皮下结节病的临床病理研究

背景:皮下结节病是结节病的一种特殊皮肤损害,罕有报道。目的:分析10例皮下结节病患者的临床病理特征及其与该病系统性特征的关系。患者和方法:1974-2002年间在西班牙Barcelona一所大学医院诊断为系统性结节病,之后发展为有皮下损害的患者纳入本研究。系统性结节病的诊断采用传统标准。所有患者均在医院的结节病门诊接受前瞻性随访监测。临床疑似肉芽肿性皮损的患者均行皮肤活检。结果:480例系统性结节病患者中,85例有肉芽肿性皮损。这85例患者中,10例(11.8%)诊断为皮下结节病。皮损最常发生于四肢,9例位于前臂。5例患者的线状硬结带从肘部…     

PET/CT影像诊断为肺癌性淋巴管炎的肺结节病1例报告及文献复习

目的：探讨肺结节病的临床特点、诊断和治疗方法,提高临床医生对该疾病的认识。方法：收集1例肺结节病患者的临床资料、支气管镜和病理检查结果,并进行相关文献复习。结果：患者因咳嗽、渐进性呼吸困难2个月入院,查体未见明显阳性体征。胸部CT显示双肺多发结节影,双肺门及纵隔淋巴结肿大;PET-CT影像诊断为肺癌伴癌性淋巴管炎（PLC）,双侧锁骨上、双肺门及纵隔淋巴结转移。入院后纤维支气管镜病理回报肺组织内见慢性肉芽肿性炎,未见明确坏死,不能完全排除结核。给予患者糖皮质激素和预防性抗结核治疗,1个月后复查胸部CT显示双肺结节明显减少,3个月后患者症状消失,胸部CT显示双肺结节基本消失,肺门和纵隔淋巴结明显缩小,最终诊断为肺结节病。结论：结节病的确诊应主要依据患者的病理诊断并结合临床表现,仅凭临床表现和影像学结果易误诊为肿瘤或者结核。     

多系统结节病误诊为淋巴瘤一例并文献分析

目的 提高对多系统结节病的认识及诊治水平, 避免漏诊、误诊。方法 结合相关文献复习对1 例多系统结节病患者的诊治进行分析。结果 患者表现为咳嗽、咳痰, 临床症状无特异性。结节病最易侵犯肺及其他胸部脏器, 胸部增强CT特点为双侧肺门淋巴结对称性增大, 伴或不伴纵隔淋巴结增大, 肿大淋巴结边界清楚, 强化均匀, 未见融合。PET/CT 显像中肿大淋巴结多呈结节样、对称分布。支气管镜下可见支气管黏膜炎症和黏膜结节。结节病的确诊依靠病理学检查。典型的结节病病理表现为散在、紧密的非干酪样坏死性肉芽肿。激素治疗有效。结论 结节病是一种病因不明的全身多系统疾病, 缺乏特异性临床表征, 因而容易误诊。影像学检查及相关实验室检查有助于结节病的诊断。确诊依靠病理检查。     

结节病伴乳糜胸一例并文献复习

目的 观察分析结节病伴乳糜胸的临床特征、诊断、治疗,以提高临床医生对该病的认识.方法 分析南京医科大学第一附属医院病理确诊的首例结节病伴乳糜胸患者的临床资料,并检索复习PubMed的10例结节病伴乳糜胸患者的发病年龄、性别、临床表现、实验室检查、治疗和预后.结论 本例为年轻男性患者,以胸痛、咳嗽为首发症状;胸部CT示全...     

结节病误诊结核病18例分析

目的：本文对结节病误诊结核病18例进行分析，以提高对结节病认识。方法：通过临床观察，胸部x线，纤支镜活检，实验室检查分析。结果：造成误诊原因为①对结节病认识不足，②胸部x线易混淆，③病理检查取材困难，Keveim试剂来源限制，难以取得病理依据。结论：胸内结节病难以排除结核病时，可作SACE活性测定，纤支镜内肺活检及肺功能检查，以提高结节病诊断与结核病的鉴别。     

Characteristics of patients with a diagnosis of sarcoidosis: a comparison of the 2006 and 2015 versions of diagnostic criteria for sarcoidosis in Japan

Objective: Histological verification of epithelioid cell granuloma is important in diagnosing sarcoidosis; tissue sampling is a worldwide requirement. In 2006, to reduce medical expenses and avoid invasive procedures, diagnostic criteria without histological verification were permitted by the Japanese government. In 2015, new diagnostic criteria, allowed clinical diagnoses based on only respiratory, ocular, and cardiac systems with at least a two-system involvement, increasing the need to sample tissue from clinically unevaluable organs in suspected sarcoidosis. This study aimed to compare the characteristics of patients who were diagnosed with sarcoidosis according to the 2006 and 2015 criteria.Materials and Methods: Using the 2015 version, we re-evaluated the characteristics of 264 patients with diagnosed or suspected sarcoidosis according to the 2006 criteria, at Jichi Medical University Hospital between 2004 and 2012 (clinical diagnosis, 84; histological diagnosis, 117; suspected sarcoidosis 63).Results: Thirty-nine patients were diagnosed with suspected sarcoidosis due to the absence of at least a two-system involvement; two patients had insufficient laboratory data suggestive of sarcoidosis. Six patients moved from suspected sarcoidosis to a histological diagnosis because of a greater leniency in the criteria for supportive findings. The 2015 diagnostic criteria excluded patients with organ involvement without a requirement for systemic steroids from the clinical diagnosis group. A case of schwannoma, erroneously placed in the clinical diagnosis group by the 2006 criteria, was reclassified according to the 2015 criteria.Conclusion: The 2015 version is preferable for clinically diagnosing sarcoidosis, even without histological specimens, and provides guidance for indications for systemic treatment.     

A case of sarcoidosis presenting as cranial polyneuritis

A Chinese female patient presented with cranial polyneuritis of unknown aetiology. Three years later, the diagnosis became obvious when she developed other features of sarcoidosis. This is the first reported local case of sarcoidosis presenting initially with nervous system involvement. It also highlighted sarcoidosis as a possible aetiology in cases of idiopathic cranial polyneuritis.     

Subcutaneous sarcoidosis mimicking carcinoma of the breast

A 65 year old woman presented with bilateral breast lumps. Clinical examination suggested a diagnosis of mammary carcinoma, but a histological diagnosis of sarcoidosis was made. Subsequent investigations revealed evidence of pulmonary sarcoidosis.     

实时荧光定量PCR在结节病与不典型结核鉴别诊断中的临床应用

目的验证和评价实时荧光定量PCR（polymerase chain reaction）的方法检测结核分枝杆菌DNA在结节病与不典型结核病鉴别诊断中的实际应用价值。方法以2008年6月至2009年6月期间,经病理活检证实为肉芽肿性疾病,但无法确定为结节病或结核病的49例患者为研究对象。运用我科前期建立的实时荧光定量PCR的方法检测上述患者石蜡包埋病理组织标本中的结核分枝杆菌DNA（Tuberculosis polymerase chain reaction,TBPCR）,以1.14×10~3拷贝/ml作为鉴别结节病与不典型结核病的最佳cutoff值,结合临床、影像、病理和其他检查结果帮助临床鉴别诊断并指导用药。随访所有患者至2009年8月1日,通过临床表现、影像学、治疗效果等变化来验证和评价本方法的实际应用价值。结果 49例患者定量TB-PCR结果中,10例患者结核分枝杆菌DNA为阳性（2.01×10~3～7.98×10~4拷贝/ml）（阳性率20.41%）,39例为阴性。结合患者临床资料及TB-PCR结果确定诊断,33例为结节病,2例结核病,诊断明确率达到72%（35/49）。诊断明确患者治疗后随访（2～14个月）,33例结节病和2例结核病患者经相应治疗均达到稳定或不同程度好转,无1例出现病情恶化。结论实时定量PCR法检测石蜡包埋组织中结核菌DNA能灵敏而高效地检出不典型结核病肉芽肿中的结核杆菌DNA,可作为鉴别结节病和不典型结核病的有效方法之一。     

结节病的支气管病变

目的　分析具有气道病变的结节病的临床表现与实验室检查特点。方法　回顾性分析 1989年 4月～ 2 0 0 4年 3月行支气管镜检查的 2 2例结节病患者的临床资料 ,比较有气道粟粒状结节改变 (A组 )和无气道粟粒状改变 (B组 )的结节病患者的临床与实验室特点。结果　A组患者中胸闷与浅表淋巴结肿大较B组多见 ;纤维支气管镜下A组患者无黏膜增厚表现 ;肺功能检查及其他实验室指标两组无明显差异。结论　结节病气道粟粒状结节改变与其临床症状、X线表现、肺功能改变及结节病分期无明显相关性 ,故对疑似结节病的患者均应行支气管镜检查以获取病理诊断     

Reactivation of old scars: inevitably sarcoid

Reactivation of pre-existing scars, as a manifestation of cutaneous sarcoidosis, is uncommon and the clinical significance of this odd symptom often remains unrecognised. In the appropriate setting a skin biopsy may serve to establish the diagnosis of sarcoidosis and avoid more invasive attempts at obtaining tissue. The case of a 72 year old man with remote reactivation of multiple cutaneous scars associated with a febrile illness, malaise, and hilar adenopathy is reported. A scar biopsy revealed multiple non-caseating granulomas and established the diagnosis of sarcoidosis. A short course of steroids was successful in causing regression of symptoms and cutaneous inflammation. Regression of inflammation in the scar provides a simple way to monitor response to treatment in this multisystem disease.     

Sarcoidosis presenting as multiple pulmonary nodules and nephrotic syndrome

A 56 year old man presented with thrombophlebitis, nephrotic range proteinuria and multiple pulmonary nodules. A renal biopsy showed membranous glomerulonephritis, and after a thoracotomy a diagnosis of sarcoidosis was established. A pulmonary nodular pattern is unusual in sarcoidosis and is often mistaken for malignant disease. The association of this type of pulmonary involvement and membranous glomerulonephritis as the presenting form of sarcoidosis has not previously been described.     

纵隔镜检查在胸部结节病诊断中的价值

目的探讨纵隔镜检查术在胸部结节病诊断中的应用价值。方法回顾性分析北京大学人民医院胸外科自1999年11月至2004年6月,30例胸部影像学检查发现纵隔肿大淋巴结,但临床难以明确诊断,经纵隔镜检查术后确诊为结节病患者的临床资料。这些患者均经纵隔镜活检,获取气管周围、胸骨后、隆突下以及双侧肺门等部位的肿大淋巴结并送病理检查。结果本组患者术前诊断为恶性病变者17例,包括纵隔转移癌8例、肺癌6例、恶性淋巴瘤3例;良性病变者13例,包括结节病12例、纵隔淋巴结核1例。术后全部经病理证实为胸部结节病,其中Ⅰ期24例,Ⅱ期6例。术前术后诊断符合率40％(12／30),有57％(17／30)的患者术前误诊为恶性肿瘤,其中3例结节病患者因术前误诊肺癌或淋巴瘤,已在外院接受了化疗。30例患者均手术顺利,无手术死亡及并发症。结论纵隔镜检查术安全、可靠,对于Ⅰ、Ⅱ期胸部结节病是一种有效的诊断和鉴别诊断方法。     

Palmar erythema and hoarseness: an unusual clinical presentation of sarcoidosis

Palmar erythema is a very unusual manifestation of sarcoidosis. We report on a patient whose presenting features of sarcoidosis were palmar erythema and a hoarse voice. The diagnosis was confirmed by palmar skin biopsy and the patient responded well to treatment with prednisolone.