Zhang Xiao-Tong, Jin Zhe, Zhang Qing, Li Run-Min, Xu Min, Babak Falahat, Anniko Matti, Duan Maoli
Department of Otorhinolaryngology, 2nd Affiliated Hospital of Xi'an JiaoTong University, Xi'an, ShanXi, PR China.
Acta Otolaryngol. 2010 Aug;130(8):971-6. doi: 10.3109/00016480903515386.
Congenital unilateral pulmonary malformation can easily be misdiagnosed as a bronchial foreign body. Although rigid bronchoscopy helps the proper diagnosis, high risks associated with anesthesia and operative complications may limit its application. However, high-resolution computed tomography (CT) and three-dimensional lung reconstruction provide a non-invasive tool to improve the diagnosis of congenital unilateral pulmonary malformation.
To compare clinical manifestations, physical signs, and radiological examinations of congenital unilateral pulmonary malformation and bronchial foreign body, and summarize the characteristics and methods for diagnosis of congenital unilateral pulmonary malformation.
Fourteen patients (five males and nine females, aged from 3 months to 14 years) with congenital unilateral pulmonary malformation, who were misdiagnosed or suspected as having bronchial foreign body or bronchial foreign body with pulmonary atelectasis, were analyzed retrospectively. Three typical cases are presented in detail.
All patients were previously misdiagnosed and treated as having pneumonia. From onset to final diagnosis, the longest misdiagnosis time was 10 years, and the shortest was 2 days. Only three patients presented with a history of foreign body inhalation. Six cases were finally diagnosed as having unilateral pulmonary malformation by rigid bronchoscope, five cases by X-ray and high-resolution CT scan, two cases by CT and three-dimensional lung reconstruction, and one case by autopsy. The malformation of left and right lungs was present in five and nine cases, respectively. Among these patients, four patients also had congenital cardiovascular diseases and other malformations, two patients underwent tracheotomy, and one patient died during salvage surgery.
先天性单侧肺发育不全易被误诊为支气管异物。尽管硬质支气管镜有助于正确诊断，但与麻醉相关的高风险和手术并发症可能会限制其应用。然而，高分辨率计算机断层扫描（CT）和三维肺重建提供了一种非侵入性工具，可提高先天性单侧肺发育不全的诊断水平。
比较先天性单侧肺发育不全与支气管异物的临床表现、体征及影像学检查，总结先天性单侧肺发育不全的诊断特点及方法。
回顾性分析14例先天性单侧肺发育不全患者（男5例，女9例，年龄3个月至14岁），这些患者曾被误诊或怀疑为支气管异物或合并肺不张的支气管异物。详细介绍3例典型病例。
所有患者既往均被误诊为肺炎并接受治疗。从发病到最终确诊，最长误诊时间为10年，最短为2天。仅3例患者有异物吸入史。6例最终通过硬质支气管镜确诊为单侧肺发育不全，5例通过X线及高分辨率CT扫描确诊，2例通过CT及三维肺重建确诊，1例通过尸检确诊。左肺和右肺发育不全分别有5例和9例。这些患者中，4例还患有先天性心血管疾病及其他畸形，2例行气管切开术，1例在抢救手术中死亡。
