目的 探讨支气管腔内肺放线菌病的临床特点及误诊原因.方法 回顾性分析我院收治的1例支气管腔内肺放线菌病的临床资料.结果 本例因发现右下肺内基底段低密度影半个月就诊.胸部CT示右下肺内基底段低密度影(黏液栓?肿瘤?)伴阻塞性肺炎,经多学科联合会诊,考虑支气管内低度恶性肿瘤可能性大.进一步行电子气管镜检查结合病理结果,诊断为支气管腔内肺放线菌病,予口服莫西沙星0.4 g/d,2周后症状明显改善,复查胸部CT示病灶明显吸收.结论 支气管腔内肺放线菌病临床少见,若影像学检查提示持续存在的肺内或气管内占位性病变,应尽早行病理检查,减少误诊误治.%Objective To explore clinical characteristics and causes of misdiagnosis of pulmonary actinomy-cosis ( PA) with endobronchial involvement. Methods The clinical data of one case of PA with endobronchial in-volvement was retrospectively analyzed. Results The patient presented to our department with a low density in the lower lobe medial basal segment for half a month. Chest CT showed a low density shadow accompanied with obstruc-tive pneumonia in the lower lobe medial basal segment, which was supposed to be a mucous plug or a tumor. Multi-disciplinary discussions considered the possibility of endobronchial low-grade malignancy. The biopsy was performed on the bronchoscope, and the pathologic diagnosis was PA with endobronchial involvement. The symptoms were im-proved significantly two weeks after the patient was given oral administration of Moxifloxacin (0. 4 g/d). CT showed evident lesion absorption. Conclusion PA with endobronchial involvement is a rare disease in clinical settings. If the imaging findings indicate persistent space-occupying lesions in the lung or the trachea, early pathological exami-nation should be performed to reduce misdiagnosis.
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