您的位置：山东大学 -> 科技期刊社 -> 《山东大学学报（医学版）》

山东大学学报 (医学版) ›› 2018, Vol. 56 ›› Issue (12): 39-46.doi: 10.6040/j.issn.1671-7554.0.2017.640

• • 上一篇    

气管支气管淀粉样变3例病例报道及文献复习

庄麦松1,2,万云焱1,林殿杰1   

  1. 1. 山东大学附属省立医院呼吸内科, 山东 济南 250021;2. 乐陵市人民医院内一科, 山东 乐陵 253600
  • 发布日期:2022-09-27
  • 通讯作者: 林殿杰. E-mail:lindianjie@126.com

Tracheobronchial amyloidosis: a report of 3 cases and literature review

ZHUANG Maisong1,2, WAN Yunyan1, LIN Dianjie1   

  1. 1. Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong, China;
    2. First Department of Internal Medicine, Leling Peoples Hospital, Leling 253600, Shandong, China
  • Published:2022-09-27

PDF (PC)

79

摘要： 目的 总结气管支气管淀粉样变的临床表现、影像表现、鉴别诊断及治疗方法。 方法 报道就诊于山东大学附属省立医院经支气管镜活检病理确诊为气管支气管淀粉样变的3例病例,复习相关文献。 结果 气管支气管淀粉样变临床症状及影像学无特异性,临床症状主要为:咳嗽、胸闷、憋气、呼吸困难、咯血等,影像学上可出现管壁钙化或增厚,管腔狭窄,增强扫描可见病灶有强化,其中管壁钙化为较特异性的特征,临床误诊及漏诊常见,局限的气管支气管淀粉样变容易漏诊,病变较弥漫的可伴有肺门淋巴结肿大及钙化、肺部结节状或斑片状高密度影,容易误诊为支气管哮喘、肺结核、慢性支气管炎等疾病。 结论 气管支气管淀粉样变临床少见,症状无特异性,由临床医师对影像学观察及认识不足导致误诊漏诊常见。提高对本病的认识,对其影像学表现及临床特征综合分析,并及时行支气管镜检查,病理学显示淀粉样物质沉积,刚果红染色阳性可明确诊断,有助于减少误诊。

关键词: 气管支气管, 淀粉样变, 误诊

Abstract: Objective To explore the clinical and imaging manifestations, differential diagnosis and treatment of tracheobronchial amyloidosis. Methods The clinical data of 3 cases of tracheobronchial amyloidosis were retrospectively analyzed, and relevant literature was reviewed. Results Tracheobronchial amyloidosis exhibited no specific clinical or imaging manifestations. The main clinical symptoms included cough, chest distress, dyspnea, hemoptysis, and so on. The imaging manifestations included calcification(which was specific), thickening of wall, and narrowing of the lumen. In enhanced scanning, strengthened lesions could be observed. Clinical misdiagnosis and missed diagnosis often occurred due to localized tracheobronchial amyloidosis. Diffused lesions with hilar lymph node enlargement, calcification, and pulmonary nodular or patchy high-density shadow were often misdiagnosed as bronchial asthma, tuberculosis, chronic bronchitis and other diseases. Conclusion Tracheobronchial amyloidosis is a rare disease with no specific symptoms. Misdiagnosis and missed diagnosis frequently occur due to insufficient clinical and imaging understanding of the disease. Comprehensive analysis of the imaging manifestations and clinical characteristics, together with bronchoscopy and pathological examination, can help avoid possible misdiagnosis.

Key words: Tracheal bronchus, Amyloidosis, Misdiagnosis

中图分类号: 

  • R562
[1] 赵杰, 叶宁, 于铁链. 原发性气管支气管淀粉样变的影像表现(附1例报告)[J]. 天津医科大学学报, 2006, 12(2): 344-345.
[2] 黄东阳. 气管支气管淀粉样变MSCT表现及文献复习[J]. 罕少疾病杂志, 2014, 21(3): 31-34.
[3] 陈静璐, 徐志豪, 沈华浩. 原发性支气管肺淀粉样变三例临床分析[J]. 临床内科杂志, 2005, 22(6): 406-408. CHEN Jinglu, XU Zhihao, SHEN Huahao, et al. Analysis of 3 cases of primary bronchial and pulmonary amyloidosis[J]. Journal of Clinical Internal Medicine, 2005, 22(6): 406-408.
[4] 郑纪阳, 戴新建, 郑永克. 支气管肺淀粉样变20例综合分析[J]. 实用临床医学, 2008, 9(2): 38-39.
[5] 谢强, 孙卫红, 黄建钗. 原发性肺淀粉样变1例[J]. 现代中西医结合杂志, 2007, 16(9): 1250-1251.
[6] 夏继国. 弥漫性气管支气管淀粉样变1例[J]. 南京医科大学学报, 2002, 22(2): 86.
[7] 魏辉平, 邹国明, 史梅. 原发性气管-支气管淀粉样变1例引发对呼吸系淀粉样变疾病的认识[J].中国医药导报, 2007, 4(35): 107.
[8] 谢正福, 廖宁, 许辉. 弥漫浸润型支气管淀粉样变性3例分析[J]. 临床荟萃, 2003, 18(14): 832-833.
[9] 张肖恩, 马俊义, 周家凤. 呼吸道淀粉样变性1例[J]. 河北医药, 1994, 16(6): 392.
[10] 张祖贻, 朱晓莉, 高庆梅. 原发性支气管淀粉样变(附3例报告及文献复习)[J]. 江苏医药, 1999, 25(2): 119-120.
[11] 杨文杰, 王枢传, 陶家驹, 等. 原发性支气管肺淀粉样变1例报告[J]. 中国内镜杂志, 2004, 10(2): 112.
[12] 王健. 支气管肺淀粉样变1例报告[J]. 承德医学院学报, 2010, 27(4): 437.
[13] 周林, 晏华琪. 支气管黏膜淀粉样变合并肺结核一例误诊分析[J]. 北京医学, 1996, 18(1): 33.
[14] 陈慧, 陈雪华. 呼吸系统淀粉样变(附2例报告并文献复习)[J]. 临床医学, 2002, 22(2): 46-47.
[15] 胡海霞, 黄勇. 弥漫性主支气管淀粉样变1例[J]. 实用医学杂志, 2007, 23(12): 1931.
[16] 寇仁业, 孙桂武. 原发性气管和支气管淀粉样变1例[J]. 临床肿瘤学杂志, 1999, 4(2): 16.
[17] 陈恒,黎毅仁. 气管、支气管淀粉样病变[J]. 临床肺科杂志, 2008, 13(9): 1222-1223.
[18] 刘丹, 彭琨, 李娜. 气管支气管淀粉样变1例[J]. 实用临床医学, 2017, 18(1): 78-80.
[19] 张春来, 黄炎明, 卢焕平. 气管支架置入治疗气管淀粉样变伴狭窄一例并文献复习[J]. 临床医学, 2016, 36(11): 36-37. ZHANG Chunlai, HUANG Yanming, LU Huanping, et al. Tracheal stent for the treatment of tracheal amyloidosis with stenosis: a case report and literature review[J]. Clinical Medicine, 2016, 36(11): 36-37.
[20] 俞昌赫, 安钟健. 气管支气管淀粉样变1例[J]. 延边大学医学学报, 2017, 40(2): 144.
[21] Zalewska KI, Brown A, McKeon DJ. An unusual cause of haemoptysis: isolated tracheobronchial amyloidosis[J]. BMJ Case Rep, 2014, 2014, pii: bcr2014205118. doi: 10.1136/bcr-2014-205118.
[22] Ren S, Ren G. External beam radiation therapy is safe and effective in treating primary pulmonary amyloidosis[J]. Respir Med, 2012, 106(7): 1063-1069.
[23] Ishii S, Kubota K, Minamimoto R, et al. Lung amyloid nodule detected by 99mTc-aprotinin scintigraphy[J]. Ann Nucl Med, 2012, 26(6): 522-526.
[24] 蔡柏蔷, 李龙芸. 协和呼吸内科学[M]. 2版. 北京: 中国协和医科大学出版社, 2011: 2396-2403.
[25] Pinney JH, Hawkins PN. Amyloidosis[J]. Ann Clin Biochem, 2012, 49(3): 229-241.
[26] Serraj M, Kamaoui I, Znati K, et al. Pseudotumoral tracheobronchial amyloidosis mimicking asthma: a case report[J]. J Med Case Rep, 2012, 30(6): 40.
[27] Berraondo J, Novella L, Sanz F, et al. Management of tracheobronchial amyloidosis with therapeutic bronchoscopic techniques[J]. Arch Bronconeumol, 2013, 49(5): 207-209.
[28] Saleiro S, Pinto Hespanhol V, Magalhaes A. Primary tracheobronchial amyloidosis - two case reports[J]. Rev Port Pneumol, 2008, 14(4): 541-544.
[29] 应央央, 马德东, 肖伟. 偏振光显微镜对诊断原发性气管支气管淀粉样变的价值并文献复习[J]. 山东大学学报(医学版), 2014, 52(4): 67-69. YING Yangyang, MA Dedong, XIAO Wei, et al. Significance of polarizing microscope for the diagnosis ofprimary tracheobronchial amyloidosis and literature review[J]. Journal of Shandong University(Health Sciences), 2014, 52(4): 67-69.
[30] Li D, Shi Z, Wang Y, et al. Primary tracheobronchial amyloidosis: coronal CT scan may provide clues for early diagnosis[J]. J Postgrad Med, 2013, 59(3): 223-225.
[31] 袁渊, 任胜男, 国小钰, 等. 局限性气管支气管淀粉样变性的CT影像学特征分析[J]. 第二军医大学学报, 2015, 36(12): 1385-1387. YUAN Yuan, REN Shengnan, GUO Xiaoyu, et al. CT features of localized tracheobronchi alamyloidosis[J]. Academic Journal of second Military Medical University, 2015, 36(12): 1385-1387.
[32] Webb EM, Elicker BM, Webb WR. Using CT to diagnose nonneoplastic tracheal abnormalities: appearance of the tracheal wall[J]. AJR Am J Roentgenol, 2000, 174(5): 1315-1321.
[33] Marrie TJ, Blanchard W. A comparison of nursing home-acquired pneumonia patients with patients with community-acquired pneumonia and nursing home patients without pneumonia[J]. J Am Geriatr Soc, 1997, 45(1): 50-55.
[34] Firlinger I, Setinek U, Koller H, et al. A case of tracheobronchial amyloidosis treated with endoscopic debulking and external beam radiation therapy[J]. Pneumologie, 2013, 67(7): 398-400.
[35] Garb JL, BrownRB, Garb JR, et al. Differences in etiology of pneumonias in nursing home and community patients[J]. JAMA, 1978, 240(20): 2169-2172.
[36] 张丽娜, 孙军平, 张明月, 等. 原发性支气管肺淀粉样变9例临床分析[J]. 解放军医学院学报, 2014, 35(3): 214-220. ZHANG Lina, SUN Junping, ZHANG Mingyue, et al. Primary bronchial and pulmonary amyloidosis: a clinical analysis of 9 cases[J]. Academic Journal of Chinese PLA Medical School, 2014, 35(3): 214-220.
[37] 朱代峰,荣光生.气管-支气管淀粉样变 1 例并文献复习[J].临床肺科杂志, 2014, 19(12): 2326-2328.
[38] Santos JW, Schneider Filho A, Bertolazzi A, et al. Primary tracheobronchial amyloidosis[J]. J Bras Pneumol, 2008, 34(10): 881-884.
[1] 吕艳锋 丁克 王建新 禹化龙 贝绍生. 慢性肛瘘癌变诊疗分析[J]. 山东大学学报(医学版), 2209, 47(6): 55-57.
[2] 王丽慧,高敏,孔北华. 子宫血管肉瘤2例报告并文献复习[J]. 山东大学学报 (医学版), 2022, 60(9): 108-112.
[3] 张景良, 刘新宇, 原所茂, 王连雷. 髋关节疾病合并腰椎退行性疾病(髋腰综合征)误诊误治的原因分析[J]. 山东大学学报 (医学版), 2022, 60(5): 67-73.
[4] 王稳,董绍华,田翔宇,崔秀娟. 盆腹腔多发脾种植误诊为妇科肿瘤1例[J]. 山东大学学报 (医学版), 2020, 1(9): 116-118.
[5] 彭静, 李卉, 杜玮. 皮下注射硼替佐米的护理体会[J]. 山东大学学报（医学版）, 2014, 52(Z1): 180-181.
[6] 应央央，马德东，肖伟. 偏振光显微镜对诊断原发性气管支气管淀粉样变的价值并文献复习[J]. 山东大学学报（医学版）, 2014, 52(4): 67-69.
[7] 吕艳锋 丁克 王建新 禹化龙 贝绍生. 慢性肛瘘癌变诊疗分析[J]. 山东大学学报(医学版), 2009, 47(6): 55-57.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
版权所有 © 2018 《山东大学学报(医学版)》编辑部　
地址:山东大学科技期刊社（济南市历城区山大南路27号山东大学中心校区明德楼B座721室） 电话: 0531-88366918 E-mail: xbyxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发