收集2010年1月至2016年12月南京市胸科医院结核科确诊的支气管结核患儿共19例,对其胸部影像学表现、发病部位及支气管镜检查结果进行回顾性分析;所有患儿入院前均曾被误诊,对其误诊情况进行总结.19例患儿中,10例CT扫描表现为肺部大片状高密度影,其余9例有斑点斑片影;支气管镜下表现为溃疡坏死型8例,炎症浸润型6例,疤痕狭窄型3例,肉芽增殖型2例;根据支气管镜下所见(取病变最严重的部位),支气管结核位于上叶10例,下叶基底段4例,背段支气管3例,左主支气管2例;19例患儿中,17例主要症状为慢性咳嗽,11例存在胸闷不适;因症状不典型,在入我院前曾被误诊为支气管炎7例,咳嗽变应性哮喘4例,支原体肺炎3例,支气管哮喘2例,上气道咳嗽综合征2例,感染后咳嗽1例.作者认为,儿童支气管结核临床特征缺乏特异性,在临床诊疗中易被误诊,需要提高警惕,尽早行气管镜相关检查.%The chest imaging findings,lesions location,and bronchoscopy manifestations were retrospectively analyzed of 19 children with bronchial tuberculosis from January 2010 to December 2016 in Department of Tuberculosis,Nanjing Chest Hospital.All of the children were misdiagnosed before admission.The misdiagnosis was also summarized.Among the 19 cases,10 cases showed a large high-density shadow in pulmonary on chest CT,and 9 cases showed spot patchy shadow.Performances under bronchoscope indicated 8 cases with ulcers necrosis,6 cases with inflammation infiltration,3 cases with scar type,and 2 cases with proliferative granulation.According to bronchoscopy for the most serious region,there were 10 cases with bronchial tuberculosis lesions located in the upper lobe,4 cases in the basal segment of the lower,3 cases in the dorsal segmental,and 2 cases in the left main bronchus.The main symptom of 17 cases was chronic cough,and 11 cases had complaint of chest tightness and discomfort.Due to these atypical symptoms,19 children were misdiagnosed as bronchitis (n=7),cough allergic asthma (n=4),mycoplasma pneumonia (n=3),bronchial asthma (n=2),upper airway cough syndrome (n=2) or cough after infection (n=1) before admitted to our hospital.We conclude that the clinical characteristics of bronchial tuberculosis in children are lack of specificity,and can easily be misdiagnosed in clinical.Thus,we need to be more cautious in order to diagnose bronchial tuberculosis by timely using bronehoscopy.
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