成人纵隔淋巴结结核的误诊和减少误诊的对策

目的探讨成人纵隔淋巴结核的诊断及鉴别诊断方法。方法总结分析了我院收治的三例成人纵隔淋巴结结核的误诊原因,并复习了相关诊断技术新进展的文献。结果成人纵隔淋巴结结核缺乏特异的临床症状和普通CT影像学特征,临床医生利用增强CT,FDG-PET,经支气管针吸术（TBNA）等技术对纵隔淋巴结肿大的鉴别诊断能力还不足。结论PPD试验强阳性。或伴支气管内膜结核。或抗酸染色镜下找到杆菌（哪怕仅有一条,非分支状）,纵隔淋巴结在增强CT下有环行强化,其内有网格状增强,诊断性抗结核治疗有效等是临床确诊纵隔淋巴结结核最重要的依据。检测血管紧张素转换酶,皮肤结节和外周淋巴结（尤其是PEF—CT显示高浓聚的外周淋巴结）病理活检有益于鉴别诊断。准确定位下TBNA有利于提高诊断。动员患者进行纵隔镜检查以取得病理鉴别依据,但必须严格遵循隔淋巴结肿大一般疾病鉴别诊断的程序和步骤。

Misdiagnosis of mediastinal tuberculous lymphadenitis in adults and the countermeasures to decrease misdiagnosis

Objective To study and improve the earlier diagnosis methods of adult mediastinal tuberculous lymphadenitis.Methods The data of 3 cases with mediastinal tuberculous lymphadenitis in adults were collected in the hospital to analyze the cause of the misdiagnosis in combination with the literature about the latest progress in diagnostic techniques.Results There were less clinical special characteristics and CT imaging features in mediastinal tuberculous lymphadenitis.Our clinical doctors had less hold of the differential diagnosis of mediastinal lymphadenectasis with contrast-enhanced CT,FDG-PET,transbronchial needle aspiration(TBNA).Conclusion It is most important diagnosis basis in adult mediastinal tuberculous lymphadenitis:strong positive with PPD test,or with endobronchial tuberculosis,or find anti-acid germ in microscope(even only one and no-branch),or peripheral rim enhancement with contrast-enhanced CT,or with the effect after the experimental therapy of anti-tuberculosis.It will be beneficial to differential diagnosis to detect serum angiotensin converting enzyme(SACE),pathological biopsy of skin nodes and external lymph nodes(especially higher focus external lymph nodes with FDG-PET).Exact positioning of TBNA can improve the diagnosis of the disease.It is necessary to encourage patients to undergo mediastinoscopy for pathological basis,but must strictly abide by the orders and steps of the differential diagnosis in mediastinal lymphadenectasis.