Zhang Qiang, Wang Xinli, Yan Chengxin, Mu Yushu, Li Peifeng
Affiliated Hospital of Taishan Medical College Taian, China.
Department of Pathology, General Hospital of Jinan Military Command Jinan, China.
Int J Clin Exp Med. 2014 Nov 15;7(11):4530-3. eCollection 2014.
Gallstone ectopia in the lungs is relatively rare, which accounts for its frequent misdiagnosis. This paper reports a case found in a suspicious lung cancer surgery. The patient received intrahepatic duct stone removal surgery and partial hepatectomy five months prior to the report. He started showing symptoms of cough and hemoptysis without any apparent cause one month before this report. Enhanced computed tomography showed a solid mass in the lower lobe of the right lung, which was considered as hamartoma or lung cancer. A wedge-shaped excision was then performed in the lower lobe of the right lung. After the surgery, postoperative findings and pathological examination results showed gallstone ectopia in the lung. This case reminds us that gallstones that overflow into the intraperitoneal section can enter the thoracic cavity through diaphragmatic weakness and travel to the lung, thus forming an inflammatory mass. The case also reminds us of the following points in clinical diagnosis: 1) remove gallstones to the greatest extent during cholelithiasis surgery to prevent the stones from migrating from the intraperitoneal area, which causes intraperitoneal and thoracic cavity complications; 2) conduct routine chest imaging examination after cholelithiasis surgery during the clinical follow-up period to facilitate early detection and timely treatment of intrathoracic complications; 3) inquire whether the patients suffering from a solid mass of the lower lobe of right lung, have cholelithiasis history to facilitate clinical diagnosis and avoid misdiagnosis, mistreatment, and treatment delay.
肺部胆结石异位相对罕见,这也是其常被误诊的原因。本文报告了一例在疑似肺癌手术中发现的病例。该患者在报告前五个月接受了肝内胆管结石清除术和部分肝切除术。在本报告前一个月,他无明显诱因开始出现咳嗽和咯血症状。增强计算机断层扫描显示右肺下叶有一个实性肿块,当时被认为是错构瘤或肺癌。随后在右肺下叶进行了楔形切除术。术后,术后检查结果和病理检查结果显示肺部存在胆结石异位。该病例提醒我们,溢入腹腔段的胆结石可通过膈肌薄弱处进入胸腔并转移至肺部,从而形成炎性肿块。该病例在临床诊断方面还提醒我们以下几点:1)在胆结石手术期间最大程度地清除胆结石,以防止结石从腹腔区域迁移,引发腹腔和胸腔并发症;2)在临床随访期间,胆结石手术后进行常规胸部影像学检查,以便早期发现并及时治疗胸腔内并发症;3)询问右肺下叶有实性肿块的患者是否有胆结石病史,以利于临床诊断,避免误诊、误治和治疗延误。