Infectious Disease Division, Winthrop-University Hospital, Mineola, New York 11501, USA.
Heart Lung. 2012 Jan-Feb;41(1):83-6. doi: 10.1016/j.hrtlng.2010.07.014. Epub 2011 Apr 11.
Depending on the community-acquired pneumonia (CAP) pathogen, host factors, and immune status, CAPs resolve on chest x-rays at different rates. CAPs that resolve more slowly than expected, or not at all, are termed "slowly or non-resolving CAPs." In contrast, recurrent CAPs may be due to host defense defects (eg, multiple myelomas) or post-obstructive bronchogenic carcinomas. There are a variety of noninfectious disorders that may mimic CAPs on chest x-ray: alveolar hemorrhage, pulmonary drug reactions, radiation pneumonitis, Wegener's granulomatosis, bronchiolitis obliterans organizing pneumonia, bronchogenic carcinomas, and lymphomas. Noninfectious mimics of recurrent CAPs include congestive heart failure, pulmonary emboli, infarctions, sarcoidosis, and systemic lupus erythematosus pneumonitis. We present the case of a middle-aged man who presented with recurrent right middle lobe and right lower lobe CAPs. Diagnostic bronchoscopy showed no bronchial obstruction, but open lung biopsy showed bronchoalveolar carcinoma (well-differentiated adenocarcinoma). Bronchoalveolar carcinomas presenting as post-obstructive or recurrent CAPs are rare because the spread is along tissue planes and not endobronchially. The case described demonstrates a rare cause of bronchogenic carcinoma mimicking recurrent CAP.
根据社区获得性肺炎 (CAP) 的病原体、宿主因素和免疫状态，CAP 在 X 光胸片上的消退速度不同。比预期消退更慢或根本不消退的 CAP 称为“缓慢或非消退性 CAP”。相比之下，复发性 CAP 可能是由于宿主防御缺陷（例如多发性骨髓瘤）或后阻塞性支气管肺癌引起的。有多种非传染性疾病可能在 X 光胸片上模拟 CAP：肺泡出血、肺药物反应、放射性肺炎、韦格纳肉芽肿、闭塞性细支气管炎伴机化性肺炎、支气管肺癌和淋巴瘤。复发性 CAP 的非传染性模拟物包括充血性心力衰竭、肺栓塞、梗死、结节病和系统性红斑狼疮性肺炎。我们提出了一例中年男性，他反复出现右中叶和右下叶 CAP。诊断性支气管镜检查未发现支气管阻塞，但开胸肺活检显示为细支气管肺泡癌（高分化腺癌）。以阻塞后或复发性 CAP 形式出现的细支气管肺泡癌很少见，因为其扩散是沿着组织平面进行的，而不是沿着支气管内进行的。所描述的病例展示了一种罕见的支气管肺癌模拟复发性 CAP 的原因。
