巨型肺大泡并气胸二例误诊分析

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1、临床误诊误治２０15年12月第28卷第12期ＣｌｉｎｉｃａｌＭｉｓｄｉａｇｎｏｓｉｓ＆Ｍｉｓｔｈｅｒａｐｙ熏Ｖｏｌ．28熏Ｎｏ．12熏Dec２０15·11··误诊研究:呼吸系及胸部疾病·巨型肺大泡并气胸二例误诊分析庞瑶，朱自江［摘要］目的分析巨型肺大泡伴气胸形成的临床特点及误诊原因，旨在提高对该类疾病的认识。方法对巨型肺大泡伴气胸形成2例的临床资料进行回顾性分析，并复习相关文献。结果本文2例均因气短并呼吸困难在当地医院就诊，经X线胸片诊断为气胸，行胸腔闭式引流术，症状未见好转。入我科后经CT检查2例均确诊为单侧巨型肺大泡伴气胸形成，行肺大泡

2、切除术及胸膜固定术后恢复良好，痊愈出院。结论接诊X线提示肺部大面积透亮区并呼吸困难者要考虑到肺大泡可能，严禁穿刺，应及时行影像学随访并进一步行CT检查，尽早明确诊断并积极手术治疗。［关键词］肺大泡;气胸;误诊［中国图书资料分类号］Ｒ563［文献标志码］A［文章编号］1002-3429(2015)12-0011-03［DOI］10．3969/j．issn．1002-3429．2015．12．005MisdiagnosisAnalysisofTwoCasesofGiantBullae-associatedPneumothorax12PANGYa

3、o，ZHUZi-Jiang(1．GansuUniversityofChineseMedicine，Lanzhou730000，China;2．TheSecondDepartmentofChestSurgery，GansuProvincialHospital，Lanzhou730000，China)［Abstract］ObjectiveToanalyzeclinicalfeaturesandcausesofmisdiagnosisofbullae-associatedpneumothoraxinordertoraiseawarenessreg

4、ardingbullae-associatedpneumothoraxthroughtwocasesandthecorrespondingreviewofliterature．MethodsTheclinicaldataoftwobullae-associatedpneumothoraxwasretrospectivelyanalyzedandtherelevantliteraturewasreviewed．ＲesultsBoththepatientsweremisdiagnosedashavingpneumothoraxwiththesy

5、mptomofshortnessofbreath，andcloseddrainageofpleuralcavitywasperformed．Afterthesurgery，thepatientsdidnotshowclinicalimprovement．Thepa-tientsweretransferredtoourdepartmentandunderwentCTexamination，whichconfirmedthediagnosisofgiantbullae．Thepatientswerecuredafterundergoinggai

6、nbullaremovaloperationandpleurodesis．ConclusionThepatientswithshortnessofbreathandlargeradiolucentareabyX-rayshouldbesuspectedashavingpulmonarybullae．Puncturemustnotbedone．Thepatientsshouldbefollowedupbychestcomputedtomographyandfurtherimagingexaminations．Assoonasthediseas

7、eiscon-firmed，anexploratorythoracotomyshouldbeperformed．［Keywords］Giantbulla;Pneumothorax;Misdiagnosis1病例资料未见苍白及发绀，无杵状指。气管居中，胸廓对称，【例1】男，47岁。因气短并呼吸困难3个月左肺叩诊呈鼓音并伴呼吸音减低，未闻及明显干湿就诊。3个月前无诱因出现气短并呼吸困难，在当性啰音。心界不大，心律齐，各瓣膜区未闻及病理性地医院查血尿便常规、血生化等均未见明显异常，摄杂音;腹部查体未触及明显异常。入院后行胸部CTX线胸片检查示左肺

8、大面积透亮区(图1)。诊断为扫描(图2)示:左肺巨型肺大泡并气胸形成。诊断气胸并行胸腔闭式引流术(术中未见大量气泡涌为左侧肺大泡伴气胸形成。拟行手术治疗，术前行出)，术后1d复查