CAJ | 학술논문

目的：总结临床表现与病理检查不符的老年社区获得性肺炎( community-acquired pneumoma, CAP)的诊治经验,以减少误诊误治。方法对我院收治的1例病理检查提示肺结核的老年CAP的临床资料进行回顾性分析。结果本例因咳嗽、咳痰,伴发热、畏冷及寒战10 d入院,查血白细胞18.5×109/L,中性粒细胞0.952,C反应蛋白150 mg/L,降钙素原1500 ng/L,胸部CT检查示左下肺实变影、边界模糊,考虑CAP,予抗感染治疗1周后症状好转,CT检查病灶较前略增大,行经皮肺穿刺病理检查提示肺结核。考虑抗感染治疗有效故而未予抗结核治疗。共抗感染治疗13 d出院。出院后6个月复查胸部CT示病灶完全吸收,随访18个月未见复发,确诊CAP。结论病理检查结果虽具有权威性,但当遇及临床表现与病理检查结果不符合时不能盲目依从病理检查结果,要结合临床情况综合分析,并动态观察病情变化,以防漏误诊。
목적：총결림상표현여병리검사불부적노년사구획득성폐염( community-acquired pneumoma, CAP)적진치경험,이감소오진오치。방법대아원수치적1례병리검사제시폐결핵적노년CAP적림상자료진행회고성분석。결과본례인해수、해담,반발열、외랭급한전10 d입원,사혈백세포18.5×109/L,중성립세포0.952,C반응단백150 mg/L,강개소원1500 ng/L,흉부CT검사시좌하폐실변영、변계모호,고필CAP,여항감염치료1주후증상호전,CT검사병조교전략증대,행경피폐천자병리검사제시폐결핵。고필항감염치료유효고이미여항결핵치료。공항감염치료13 d출원。출원후6개월복사흉부CT시병조완전흡수,수방18개월미견복발,학진CAP。결론병리검사결과수구유권위성,단당우급림상표현여병리검사결과불부합시불능맹목의종병리검사결과,요결합림상정황종합분석,병동태관찰병정변화,이방루오진。
Objective To summarize experiences of the clinical manifestations in discrepancy with pathological exam-ination in terms of the elderly community-acquired pneumonia ( CAP) to improve diagnosis and treatment in order to reduce misdiagnosis and mistreatment rates. Methods Clinical data of 1 case of CAP of suggested pulmonary tuberculosis by patho-logical examination were retrospectively analyzed. Results The patient was admitted for cough, sputum, fever, fear of cold and chill for 10 d, blood leukocyte was 18. 5 × 109/L, neutrophils was 0. 952, CRP was 150 mg/L, original calcitonin was 1500 ng/L. Chest CT examination showed a shadow of consolidation of the lung, fuzzy boundaries, and the patient was sus-pected as having CAP. The patient's symptom improved after one week of anti-infection treatment, but chest CT examination showed that the focus was expanded. Percutaneous lung biopsy suggested pulmonary tuberculosis. The anti-tuberculosis treat-ment was not given. The patient was discharged 13 d after anti-infection treatment. After a follow-up of 6 months after treat-ment, chest CT examination showed that the focus was completely absorbed. No relapse occurred during the 18 month- fol-low-up and the patient was confirmed as having CAP. Conclusion Pathologic examination result is authoritative, but in case of discrepancy between clinical manifestations and pathological findings, clinicians should not depend too much upon patholog-ical examination results. Comprehensive analysis combined with clinical situation, and observation of the dynamic change should be carried out to avoid misdiagnosis and missed diagnosis.