Chinese Medical Sciences Journal ›› 2021, Vol. 36 ›› Issue (3): 252-256.doi: 10.24920/003782

• 病例报告 • 上一篇    

竹签意外刺入胸腔引发的肺炎、多发肺梗塞和肺脓肿:一例误诊为肺结核的病例报告

瞿鹏飞1,3,白宝良2,段婷1,刘凯1,杜进良1,熊鑫1,贾彭林1,孙仲春1,雷普平1,*()   

  1. 1昆明医科大学法医学学院,昆明 650500,中国
    2红河哈尼族彝族自治州锦平县公安局刑事科技办公室,红河,云南省 661500,中国
    3北京大学医学部基础医学院病理学系,北京 100083,中国
  • 收稿日期:2020-05-10 接受日期:2020-09-15 出版日期:2021-09-30 发布日期:2021-08-09
  • 通讯作者: 雷普平 E-mail:puping.jacky@qq.com

Pneumonia, Multiple Pulmonary Infarction and Abscess Caused by a Bamboo Stick Accidentally Piercing into Chest: a Case Misdiagnosed as Pulmonary Tuberculosis

Pengfei Qu1,3,Baoliang Bai2,Ting Duan1,Kai Liu1,Jinliang Du1,Xin Xiong1,Penglin Jia1,Zhongchun Sun1,Puping Lei1,*()   

  1. 1School of Forensic Medicine, Kunming Medical University, Kunming 650500, China
    2Criminal Science and Technology Office, Jinping County Public Security Bureau, Honghe Hani and Yi Autonomous Prefecture, Yunnan 661500, China
    3Department of Pathology, School of Basic Medicine, Peking University Health Science Center, Beijing 100083, China
  • Received:2020-05-10 Accepted:2020-09-15 Online:2021-09-30 Published:2021-08-09
  • Contact: Puping Lei E-mail:puping.jacky@qq.com

摘要:

计算机断层扫描(CT)检查是发现和诊断体内异物的主要手段。CT对异物的诊断虽然具有较高的敏感性,但仍有一些干扰因素可能导致漏诊或误诊。我们报告一个罕见的案例。一青年男性被一根竹签意外地刺入左胸。由于特殊原因,该竹签一直残留胸腔三年而未被发现。患者初以咳嗽、胸痛、发热、咯血在当地医院多次住院诊治,痰涂片未检出结核杆菌,胸部CT检查发现左肺结节、双肺粟粒状及空洞阴影,临床先后诊断为原发性肺结核及继发性肺结核。3年间他接受抗结核治疗,但症状未见改善。直到去世前一个月,在另一家医院通过螺旋CT检查和三维重建发现胸腔内这根竹签异物。尸体解剖检验确认死因为肺炎、肺梗死和多发肺脓肿。本文分析了该病例误诊的因素,旨在为临床中异物合并肺部炎症的诊断和治疗提供参考。

关键词: 异物, 肺炎, 肺脓肿, 肺结核, 误诊

Abstract:

Computed tomography (CT) examination is the major measure for detecting and diagnosis of foreign bodies in human body. Although CT has high sensitivity in diagnosis of foreign body, some interference factors may still lead to missed diagnosis or misdiagnosis. Here we report a rare case that a bamboo stick accidentally pierced into the left chest of a young man who was drunk and unware of this hurt. The patient experienced cough, chest pain, fever, hemoptysis, and was misdiagnosed as primary and secondary tuberculosis based on chest CT examinations at a local hospital, although no tubercular bacillus detected by sputum smear. He subsequently received anti-tuberculous treatments in the following three years, but no improvement of his symptoms was observed. Until one month before his death, the bamboo stick was detected by spiral CT examination as well as three-dimensional image reconstruction at another hospital. Postmortem examination revealed pneumonia, pulmonary infarction, and abscess as the causes of his death. We analyze the potential reasons of misdiagnosis in this case, aiming to provide reference for the diagnosis and treatment of pulmonary inflammation associated with foreign body in the future.

Key words: foreign body, pneumonia, pulmonary abscess, pulmonary tuberculosis, misdiagnosis

基金资助: 国家自然科学基金(81460285)

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