临床误诊误治2023，Vol.36Issue(8)：13-17,5.DOI:10.3969/j.issn.1002-3429.2023.08.003
误诊为社区获得性肺炎的隐源性机化性肺炎临床分析
Clinical Analysis of Cryptogenic Organizing Pneumonia Misdiagnosed as Community-acquired Pneumonia
摘要
Abstract
Objective To investigate the clinical characteristics of cryptogenic organizing pneumonia(COP)and the causes and preventive measures of misdiagnosis as community-acquired pneumonia(CAP).Methods The clinical data of 29 patients with COP which was initially misdiagnosed as CAP from January 2014 to June 2022 were retrospectively analyzed.Re-sults Among the 29 cases,there were 20 cases with cough,12 cases with sputum,9 cases with chest tightness,7 cases with shortness of breath after exercise,and 3 cases with chest pain.Fever occurred in 14 cases,anorexia in 6 cases,weight loss in 5 cases and fatigue in 3 cases.Pulmonary auscultation showed local moist rales in 14 cases,wheezing in both lungs in 10 ca-ses,and crackles in both lungs in 7 cases.Leukocytes increased in 14 cases and neutrophils increased in 8 cases.C reactive protein increased in 14 cases,and erythrocyte sedimentation rate increased in 9 cases.Pulmonary function examination all in-dicated diffuse dysfunction.Chest CT examination revealed inflammatory pulmonary lesions.All the 29 cases were initially di-agnosed with CAP and responded poorly to antibiotics.Superior doctors were invited to consult and considered that the infec-tion was a special pathogen.CT-guided percutaneous biopsy of lung was performed in 21 cases,and bronchoscopic biopsy of lung was performed in 8 cases;secondary organizing pneumonia was ruled out and they were diagnosed as COP.The duration of misdiagnosis was(17.24±2.17)d.Twenty-nine cases were treated with prednisone after discontinuation of antibiotics.After 6 to 12 months,all the 29 cases were relieved,and the drug was discontinued.There was no recurrence at 6 months af-ter follow-up.Conclusion COP is rare in clinical practice,and its early clinical and imaging manifestations are nonspecific;therefore,it is more likely to be misdiagnosed as CAP.Improving clinicians＇understanding of COP,carefully performing dif-ferential diagnosis,dynamically observing imaging changes of patients before and after treatment,timely performing diagnostic treatment and pathological examination can reduce the clinical misdiagnosis rate.关键词
隐源性机化性肺炎/误诊/社区获得性肺炎/体层摄影术,螺旋计算机/病理学检查/诊断/鉴别诊断/糖皮质激素Key words
Cryptogenic organizing pneumonia/Misdiagnosis/Community-acquired pneumonia/Tomography,spiral computed/Pathological examination/Diagnosis/Differential diagnosis/Glucocorticoids分类
临床医学引用本文复制引用
董学峰,常乐,傅金木..误诊为社区获得性肺炎的隐源性机化性肺炎临床分析[J].临床误诊误治,2023,36(8):13-17,5.基金项目
泉州市科技计划项目(2022NS072) （2022NS072）
