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气管支气管多结节异常:支气管镜检查结果与临床诊断

Multinodule abnormalities of the tracheobronchus: bronchoscopy findings and clinical diagnosis.

作者信息

An Jian, Yang Hua-Ping, Hu Cheng-Ping, Cao Li-Ming, Zhou Ya-Fang, Xiao Qi-Ming, Pan Pin-Hua, Luo Bai-Ling, Meng Jie, Zheng Zhi-Yuan, Su Xiao-Li, Li Yuan-Yuan

机构信息

Department of Respiratory & Critical Care Medicine (Key cite of National Clinical Research Center for Respiratory Disease), Xiangya Hospital, Central South University, Changsha, Hunan province, China.

Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan province, China.

出版信息

Clin Respir J. 2017 Jul;11(4):440-447. doi: 10.1111/crj.12356. Epub 2015 Sep 21.

Abstract

BACKGROUND AND AIMS

Bronchoscopy is an important method for diagnosing respiratory disease. Multiple tracheobronchial nodules are rarely reported and their causes remain unclear.

OBJECTIVES

The aim of this study was to describe the clinical characteristics of multiple nodule tracheobronchial abnormalities found under bronchoscopy caused by different diseases.

METHODS

Eighty-seven patients with multiple tracheobronchial nodules were enrolled in this study. The characteristics of the multinodule lesions and the patient were diagnosed based on the pathology findings in our hospital. Chest computed tomography images were retrospectively reviewed by pulmonologists and radiologist.

RESULTS

In 55 patients with definite pathological diagnosis, 16 (29%) patients were diagnosed as tuberculosis (TB) granuloma; 23 (41.8%) cases were diagnosed as malignant disease; 12 (21.8%) cases were diagnosed as tracheobronchopathia osteochondroplastica; 2 (3.6%) cases were diagnosed as sarcoidosis; and one case (1.8%) was diagnosed as lymphoma and one case (1.8%) as fungal infection. There were 32 cases of chronic inflammation. There was no relationship between nodule distribution and the pathological diagnosis. Malignant nodules usually smaller with a pale outlook, while nodules with larger size and smooth and intact mucosa usually turn out to be granuloma of unknown reason.

CONCLUSION

The major causes of mutinodule lesions observed using bronchoscopy are tumor and TB. The presence of multiple endotracheobronchial nodules suggest that pulmonary lesion is present, and biopsy should be performed. Malignant nodules can be diagnosed by appearance and biopsy. Pathology results of TB, sarcoidosis and fungal infection can turn out to be granuloma of unknown reason. Further diagnosis needs other clinical materials.

摘要

背景与目的

支气管镜检查是诊断呼吸系统疾病的重要方法。气管支气管多发结节鲜有报道,其病因尚不清楚。

目的

本研究旨在描述支气管镜检查发现的由不同疾病引起的气管支气管多发结节异常的临床特征。

方法

本研究纳入了87例气管支气管多发结节患者。根据我院的病理结果诊断多结节病变及患者特征。肺科医生和放射科医生对胸部计算机断层扫描图像进行回顾性分析。

结果

在55例明确病理诊断的患者中,16例(29%)被诊断为结核(TB)肉芽肿;23例(41.8%)被诊断为恶性疾病;12例(21.8%)被诊断为骨软骨化生气管支气管病;2例(3.6%)被诊断为结节病;1例(1.8%)被诊断为淋巴瘤,1例(1.8%)被诊断为真菌感染。有32例为慢性炎症。结节分布与病理诊断之间无相关性。恶性结节通常较小,外观苍白,而较大且黏膜光滑完整的结节通常为不明原因的肉芽肿。

结论

支气管镜检查发现的多结节病变的主要原因是肿瘤和结核。气管支气管内多发结节提示存在肺部病变,应进行活检。恶性结节可通过外观和活检诊断。结核、结节病和真菌感染的病理结果可能为不明原因的肉芽肿。进一步诊断需要其他临床资料。

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