临床误诊误治2026，Vol.39Issue(1)：17-23,7.DOI:10.3969/j.issn.1002-3429.2026.01.004
以骨转移症状为首发表现的肺癌误诊原因及影像学特征分析
Analysis of misdiagnosis causes and imaging features of lung cancer with bone metastasis symptoms as the initial manifestation
摘要
Abstract
Objective To investigate misdiagnosis causes and imaging features of lung cancer with bone metastasis symptoms as the initial manifestation.Methods A retrospective analysis was conducted on the case data of 8 patients with lung cancer and bone metastases who were initially misdiagnosed as having osteoarthritis,vertebral osteophytes,or primary bone tumors from January 2022 to January 2024.Results Among the 8 patients,there were 5 males and 3 females,aged from 45 to 72 years.Four cases presented mainly with persistent bone pain accompanied by limited movement.The pain sites involved the ribs in 2 patients,the ilium in 1 patient and the femur in 1 patient.According to the imaging examination results,the initial diagnosis was osteoarthritis,and the treatment with non-steroidal anti-inflammatory drugs for 2 to 3 months was ineffective.Later,due to the aggravation of symptoms,chest CT examinations were performed,and nodules in the lungs were all detected,with diameters ranging from 1.2 to 3.5 cm.CT-guided biopsy confirmed lung adenocarcinoma with bone metastasis.Two patients presented with persistent dull pain in the thoracolumbar spine,which worsened during upright activities.They were initially diagnosed as vertebral osteophyte hyperplasia through X-ray and magnetic resonance imaging examinations,and there was no improvement after 3 months of conservative treatment.Positron emission tomography-computed tomography(PET-CT)showed increased vertebral metabolism accompanied by a hypermetabolic nodule measuring 2.1 cm in diameter in the upper lobe of the right lung.The diagnosis of vertebral metastasis from lung squamous cell carcinoma was confirmed by transbronchial needle aspiration biopsy guided by ultrasound bronchoscopy.Two patients presented with local bony masses(one in the proximal humerus and one in the ilium).X-rays showed osteolytic destruction accompanied by soft tissue shadows,and the initial diagnosis was primary bone tumors.Intraoperative freezing section pathology suggested metastatic adenocarcinoma,and postoperative bronchoscopic biopsy and immunohistochemistry confirmed it as bone metastasis of lung adenocarcinoma.The misdiagnosis duration of 8 patients was 2 to 6 months.After diagnosis,all of them received comprehensive treatment of targeted/chemotherapy of the primary lesion combined with radiotherapy of bone metastases.They were followed up for 6 to 12 months.Of them,2 patients achieved partial remission,4 patients had stable conditions,and 2 patients showed disease progression(including 1 death due to multiple organ metastases).Conclusion Early-stage bone metastasis of lung cancer is often misdiagnosed as osteoarthritis,vertebral osteophytes,primary bone tumors and other bone diseases.When encountering patients with unexplained bone pain or bone destruction in clinical practice,chest imaging examinations should be completed to improve the early diagnosis rate.关键词
肺肿瘤/骨转移/误诊/骨关节炎/骨质增生/骨肿瘤/诊断/鉴别诊断Key words
lung neoplasms/bone metastasis/misdiagnosis/osteoarthritis/hyperostosis/bone neoplasm/diagnosis/differential diagnosis引用本文复制引用
杨淇茗,刘林稳,刘基,肖凤,吕龙柱,袁晓燕..以骨转移症状为首发表现的肺癌误诊原因及影像学特征分析[J].临床误诊误治,2026,39(1):17-23,7.基金项目
四川省医院协会青年药师科研专项资金项目(YP2202419) （YP2202419）
