肺上沟癌26例误诊原因分析

目的 探讨肺上沟癌的误诊原因,提高临床医生对该病的认识。方法 对1999年4月至2006年12月在中南大学湘雅医院确诊为肺上沟癌的26例患者的临床表现、影像学特点、诊断及误诊情况进行回顾性分析。结果26例中,男24例,女2例,年龄44 ～70岁,平均(59 ±6)岁。26例中肩背部疼痛25例,上肢疼痛、麻木或乏力18例,早期出现呼吸道症状（如咳嗽、咳痰）5例,Homer征阳性2例,声音嘶哑l例。26例中19例曾误诊,其中误诊为肩周炎13例,颈椎病3例,肺结核3例。26例胸部CT检查均显示一侧肺上叶尖段软组织密度增高影,其中3例患者X线胸片未见异常,3例患者因X线胸片提示肺尖部病变而误诊为“肺结核”。结论 肩背部疼痛是肺上沟癌最常见的症状;肺上沟癌容易误诊,确诊时多为中晚期;胸部CT是确诊该病最有价值的辅助检查。

Misdiagnosis of pancoast cancer: analysis of 26 cases

Objective To further understand the clinical features and the causes of misdiagnosis of pancoast cancer.Methods The data of 26 cases of pancoast cancer from 1999-2006 were collected for a retrospective review. The clinical and imaging features, and the causes underlying misdiagnosis were analyzed.Results There were 24 males and 2 females(mean age 59 ±6, range 44-70 years).The earliest clinical features of pancoast cancer included painful shoulder and back in 25 cases, upper extremity pain,palsy and numbness in 18 cases.Early respiratory symptoms such as cough and sputum were recorded in 5 cases, Horner syndrome in 2 cases, and hoarseness in 1 case.Misdiagnosis was made in 19 of the 26 cases:13 as periarthritis humeroscapularis,3 as cervical osteoarthritis and another 3 as pulmonary tuberculosis.CT scanning showed soft tissue masses at the apical segments of the lungs in all the cases(26/26).Three cases were misdiagnosed as "pulmonary tuberculosis" according to the images of X-ray, and another 3 went unnoticed.Conclusions Painful shoulder and back were the most common symptoms of pancoast cancer.pancoast cancer was often diagnosed at an advanced stage, and misdiagnosis was common.Thorax CT was the most valuable method for the detection of Pancoast cancer.