肺结核误诊为支原体肺炎六例报告

目的探讨肺结核误诊为支原体肺炎的原因及防范措施。方法回顾性分析曾误诊为支原体肺炎的肺结核6例的临床资料。结果6例均曾误诊为支原体肺炎,误诊时间9 d~2个月。临床表现为发热4例(咳黄白色黏痰2例,伴畏寒、咳嗽、痰中带血1例,干咳、咽痛1例),干咳、气短1例,咳嗽、咳痰伴头痛、头晕、胸闷1例。胸部CT检查示病变位于右肺下叶3例,左肺下叶1例,双肺弥漫病变1例,右肺多发病变1例;表现为小斑片渗出和小叶中心结节影3例(合并实变1例),实变合并磨玻璃影2例(合并小叶中心结节及支气管气相各1例),实变、呈“树芽征”和小叶间隔增厚1例。经气管镜下肺泡灌洗液抗酸染色及痰涂片抗酸染色阳性确诊各3例,确诊后予抗结核治疗,电话随访6个月,4例已完全治愈,2例治疗中,胸部CT检查提示病灶已明显吸收。结论肺结核临床及影像学表现多样,迷惑性极强,当遇到胸部CT多种表现同时存在及抗支原体治疗效果不佳的支原体肺炎患者时,应考虑到肺结核可能,若患者无痰或痰涂片抗酸染色多次阴性可行气管镜检查,以减少误漏诊。

A Report in Six Cases of Pulmonary Tuberculosis Misdiagnosed as Mycoplasma Pneumonia

Objective To investigate the causes of misdiagnosis and preventive measures of pulmonary tuberculosis(PT)as mycoplasma pneumonia.Methods A retrospective analysis was performed on the clinical data of 6 patients with PT misdiagnosed as mycoplasma pneumonia.Results All the 6 cases were misdiagnosed as mycoplasma pneumonia,and the duration of misdiagnosis was 9 d-2 months.The clinical manifestations were fever in 4 cases(2 with yellow and white phlegm,1 with chills,cough and blood in phlegm,1 with dry cough and sore throat),dry cough and shortness of breath in 1 case,cough and phlegm with headache,dizziness and chest tightness in 1 case.Chest CT examination showed that there were lesions located in the right lower lobe in 3 cases,in the left lower lobe in 1 case,the double lung diffuse lesions in 1 case,and multiple lesions in the right lung in 1 case.There were 3 cases of small patchy exudation shadow and central lobular nodule(1 case with consolidation),2 cases of consolidation combined with ground glass shadow(1 case with central lobular nodule and 1 case with bronchial gas phase),and 1 case of consolidation,with"tree bud sign"and interlobular thickening.There were 3 cases of acid-fast staining of sputum smear and 3 cases of positive acid-fast staining of bronchoalveolar lavage fluid under tracheal microscope,and anti-tuberculosis treatment was given after diagnosis.Six-month telephone follow-up showed that 4 cases were completely cured,and 2 cases were treated.Chest CT indicated that the lesions had been significantly absorbed and improved.Conclusion Clinical and imaging manifestations of tuberculosis are diverse and confusing.When encountering mycoplasma pneumonia patients with multiple chest CT findings and poor anti-mycoplasma treatment,pulmonary tuberculosis should be considered.If the patient has no sputum or multiple negative acid-fast staining tests on sputum smear,bronchoscope examination should be performed in order to reduce the misdiagnosis and missed diagnosis.