14例肺吸虫病误诊为结核的原因及胸部CT表现分析

摘要

Objective To investigate the clinical manifestations and chest CT features of paragonimiasis patients,and to analyze the causes of paragonimiasis being misdiagnosed as pulmonary tuberculosis.Methods The clinical and CT imaging features of 14 patients who were diagnosed as paragonimiasis in our hospital from January 2011 to March 2015 were retrospectively analyzed,and the reasons why paragonimiasis was misdiagnosed as tuberculosis were summarized.Results In 14 patients,there were 12 cases with clear epidemiological history.Clinical manifestations included 8 cases with cough,expectoration and chest pain,4 cases with fever and night sweating,5 cases with shortness of breath,2 cases with skin rash,3 cases with migratory subcutaneous mass,10 cases with Eosinophils increased,4 cases with CT imaging,4 cases with peribronchitis,9 cases with lung infiltrates showing unilateral or bilateral patchy and patchy shadow,Boundary blur;6 cases with typical tunnel signs,2 cases with cystic shadow,and 11 cases with pleural effusion.The lesions showed wandering in 4cases.Positive reactions were observed when 14 patients underwent antibody test of serum lung fluke.After treatment with praziquantel,the clinical symptoms improved markedly.Conclusion Chest CT has important value in the differential diagnosis of paragonimiasis and tuberculosis.Radiologists should correctly interpret CT imaging changes and should also pay attention to differences of the imaging features of the chest CT and the serials in various periods between paragonimiasis and tuberculosis.Suspected imaging changes should take the initiative to ask patients about their medical history,dig out epidemiological history,and carry out physical examination if necessary.Misdiagnosis and missed diagnosis can be avoided as much as possible when the diagnosis is finally combined with laboratory examinations.%目的 探讨肺吸虫病患者的临床表现、胸部CT特征,分析肺吸虫病误诊肺结核的原因.方法 对2011年1月至2015年3月本院收治临床确诊14例肺吸虫病患者的临床及CT系列片影像学表现进行回顾性分析,总结肺吸虫病误诊肺结核的原因.结果 14例患者,有明确流行病学史12例;临床表现:咳嗽、咳痰、胸痛8例;发热、盗汗4例;气促5例;皮疹2例;皮下游走性包块3例.嗜酸性粒细胞分类增高10例.影像学表现:支气管周围炎4例;肺浸润性改变9例,表现为单侧或双侧斑片、条片状影,边界模糊;典型“隧道征”6例;囊状影2例.胸腔积液11例.病灶呈游走性4例.14例患者行血清肺吸虫抗体检查(ELISA法),均呈阳性反应.经吡喹酮治疗后,临床症状明显好转.结论 胸部CT在肺吸虫病及肺结核的鉴别诊断中具有重要价值,放射科医师应正确判读肺吸虫病的CT影像学改变,还应重视肺吸虫病各期胸部CT及系列片影像学特点与肺结核的差异.可疑影像学改变应主动询问患者病史、挖掘流行病学史,必要时进行体格检查;最终结合实验室检查,尽可能避免误诊、漏诊.