恶性胸膜间皮瘤合并肺结核/结核性胸腔积液的临床特征分析

目的:分析恶性胸膜间皮瘤(MPM)合并肺结核/结核性胸腔积液(TPE)患者的临床特征，以加强对该类疾病的认识，减少误诊误治。方法:收集首都医科大学附属北京胸科医院2012年2月至2020年2月MPM并肺结核/TPE患者病例资料14例，回顾性分析其临床症状、体征、实验室检查，胸部影像特征等，以总结其特点。结果:剧烈且进行...

Clinical characteristics of malignant pleural mesothelioma combined with pulmonary tuberculosis/tuberculous pleural effusion

Objective To analyze the clinical characteristics of patients with malignant pleural mesothelioma(MPM)accompany with pulmonary tuberculosis/tuberculous pleural effusion(TPE),in order to avoid misdiagnosis and mistreatment.Methods The clinical data of 14 cases with MPM and pulmonary tuberculosis/TPE in the Beijing Chest Hospital,Capital Medical University)from February 2012 to February 2020 and analyzed their clinical symptoms,physical signs,laboratory examinations and chest imaging characteristics retrospectively.Results Severe and gradually aggravated chest pain was the prominent symptom of the coexistence of two diseases.The pleural effusion of MPM patients was mostly yellow exudative,and it was easy to appear on the same side of TPE.The tumor markers in serum/pleural effusion showed carcinoembryonic antigen negative and Cytokeratin fragment 21-1 ascended.Chest CT showed irregular annular thickening and nodular thickening of pleura in affected pleura of MPM patients,which covered up the original signs of tuberculous pleurisy.A total of 12 patients were diagnosed with MPM by CT guided pleural biopsy,and 2 patients were diagnosed by thoracoscopy.Conclusions The clinical manifestations and pleural effusion of patients with pulmonary tuberculosis/TPE combined with MPM are lack of specificity.Prominent and progressive chest pain,carcinoembryonic antigen negative,Cytokeratin fragment 21-1 elevated,thickening of pleura are signs of MPM.Elevated adenosine deaminase in pleural effusion suggested tuberculous pleurisy.CT guided lung puncture and thoracoscopy are effective strategy for the diagnosis.