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支气管内曲菌球:一例报告及文献复习

Endobronchial aspergilloma: A case report and literature review.

作者信息

Huang Dongdong, Li Bing, Chu Haiqing, Zhang Zhemin, Sun Qiuhong, Zhao Lan, Xu Liyun, Shen Li, Gui Tao, Xie Huikang, Zhang Jun

机构信息

Department of Clinical Medicine, Tongji University School of Medicine, Shanghai 200092, P.R. China.

Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, P.R. China.

出版信息

Exp Ther Med. 2017 Jul;14(1):547-554. doi: 10.3892/etm.2017.4540. Epub 2017 Jun 1.

DOI:10.3892/etm.2017.4540
PMID:28672965
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5488507/
Abstract

The present study aimed to investigate the clinical and radiological characteristics in addition to the bronchoscopic appearance in patients with endobronchial aspergilloma (EBA). Clinical and radiological characteristics were analyzed alongside the bronchoscopic appearance in 17 patients with EBA diagnosed by bronchoscopy with histological examination. The present study assessed the relevant literature and 13 males and 4 females were included in the comparison, with a median age of 59. Associated diseases included 8 previous diagnoses of pulmonary tuberculosis (47.6%), 4 previous diagnoses lung cancer (23.5%), 1 pulmonary resection (5.9%) and 1 bronchial foreign body (5.9%). The primary symptom was hemoptysis (9/17, 53%). Chest computed tomography (CT) indicated a markedly higher incidence of aspergillosis lesion in the left lung (13/17; 76.5%) compared with the right lung (4/17; 23.5%). CT manifestation included space occupying disease in 10 patients (58.8%), aspergilloma in 3 patients (17.6%), pneumonic consolidation in 2 patients (11.8%) and ground glass opacity in 1 patient (5.9%). Bronchoscopy examination identified masses in all 17 patients' bronchial lumen and 15 patients had endobronchial obstruction by necrotic material. The case presented in the current study demonstrated the merits of combining bronchosopic intervention with voriconazole. The dominant symptom of EBA was hemoptysis. Chest CT demonstrated that aspergillosis lesions were more frequently identified in the left lung compared with the right. EBA often occurs in individuals with underlying lung diseases, which cause lumen structural change or bronchial obstruction. EBA may be clearly diagnosed by bronchoscopy biopsy, although the potential for a co-exististing tumor requires consideration. Bronchoscopic intervention and anti-fungal therapy may have an advantage in the effective treatment of patients with EBA.

摘要

本研究旨在调查支气管内曲菌球(EBA)患者的临床、放射学特征以及支气管镜表现。对17例经支气管镜检查及组织学检查确诊为EBA的患者,分析其临床、放射学特征及支气管镜表现。本研究评估了相关文献,并纳入13例男性和4例女性进行比较,中位年龄为59岁。相关疾病包括既往8例肺结核诊断(47.6%)、4例肺癌诊断(23.5%)、1例肺切除术(5.9%)和1例支气管异物(5.9%)。主要症状为咯血(9/17,53%)。胸部计算机断层扫描(CT)显示,与右肺(4/17;23.5%)相比,左肺曲霉菌病病变的发生率明显更高(13/17;76.5%)。CT表现包括10例患者(58.8%)出现占位性病变、3例患者(17.6%)出现曲菌球、2例患者(11.8%)出现肺实变和1例患者(5.9%)出现磨玻璃影。支气管镜检查发现所有17例患者的支气管腔内均有肿物,15例患者存在坏死物质导致的支气管内阻塞。本研究中的病例展示了支气管镜干预联合伏立康唑的优点。EBA的主要症状为咯血。胸部CT显示,与右肺相比,左肺更常发现曲霉菌病病变。EBA常发生于有基础肺部疾病的个体,这些疾病会导致管腔结构改变或支气管阻塞。尽管需要考虑并存肿瘤的可能性,但支气管镜活检可明确诊断EBA。支气管镜干预和抗真菌治疗可能对EBA患者的有效治疗具有优势。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/73f5/5488507/a35f2dce4db5/etm-14-01-0547-g05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/73f5/5488507/0b0b079a0b62/etm-14-01-0547-g00.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/73f5/5488507/0fe48d622802/etm-14-01-0547-g01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/73f5/5488507/7289cc32d965/etm-14-01-0547-g02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/73f5/5488507/6a935a38104c/etm-14-01-0547-g03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/73f5/5488507/1f74185afa1d/etm-14-01-0547-g04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/73f5/5488507/a35f2dce4db5/etm-14-01-0547-g05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/73f5/5488507/0b0b079a0b62/etm-14-01-0547-g00.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/73f5/5488507/0fe48d622802/etm-14-01-0547-g01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/73f5/5488507/7289cc32d965/etm-14-01-0547-g02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/73f5/5488507/6a935a38104c/etm-14-01-0547-g03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/73f5/5488507/1f74185afa1d/etm-14-01-0547-g04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/73f5/5488507/a35f2dce4db5/etm-14-01-0547-g05.jpg

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