RESUMO
BACKGROUND: In China, tuberculous pleural effusion is the most common cause for pleural effusion. Elevated ADH and positive tuberculin test usually are characteristic of tuberculous pleural effusion. We reported a 71-year-old male patient with elevated ADH and positive tuberculin test firstly misdiagnosed as tuberculous pleural effusion finally proven as pleural mesothelial sarcoma by thoracoscopic pathology. METHODS: Appropriate laboratory tests and thoracentesis were carried out. Thoracoscopy and pathological biopsy were performed to differentiate tuberculous pleural effusion. RESULTS: Chest CT showed right pleural effusion. ADH in pleural effusion was over 45 U/L and PPD test was positive. No abnormal cells were found in pleural effusion pathology. Pathology of thoracoscopic biopsy proved pleural mesothelioma. CONCLUSIONS: Elevated ADH and positive tuberculin test are not a specific index for tuberculosis and thoracoscopic biopsy pathology is crucial for differential diagnosis.
Assuntos
Neoplasias Pulmonares/diagnóstico , Mesotelioma/diagnóstico , Oxirredutases/metabolismo , Derrame Pleural/diagnóstico , Sarcoma/diagnóstico , Tuberculose Pleural/diagnóstico , Adenosina/metabolismo , Idoso , Biópsia , Diagnóstico Diferencial , Erros de Diagnóstico , Humanos , Neoplasias Pulmonares/enzimologia , Neoplasias Pulmonares/patologia , Masculino , Mesotelioma/enzimologia , Mesotelioma/patologia , Mesotelioma Maligno , Derrame Pleural/enzimologia , Derrame Pleural/patologia , Sarcoma/enzimologia , Sarcoma/patologia , Toracoscopia/métodos , Teste Tuberculínico/métodos , Tuberculose Pleural/enzimologia , Tuberculose Pleural/patologiaRESUMO
BACKGROUND: G-lipopolysaccharide, a component of the cell wall of Gram-negative bacteria, is called lipopolysaccharide. The detection of G-lipopolysaccharide can be used for the early diagnosis of infectious diseases, but some-times G-lipopolysaccharide provides limited help. We report a case of a patient with hemoptysis and high-density shadow of both lungs combined with elevated serum G-lipopolysaccharide which mimicked bronchiectasis with Gram-negative bacterium infection. It was ultimately confirmed as Mycobacterium iranicum infection by CT-guided percutaneous lung biopsy and next generation sequencing. METHODS: The chest computed tomography (CT) scan, CT-guided percutaneous lung biopsy, and NGS were performed for diagnosis and blood tests explored for the latent etiology. RESULTS: The chest CT scan showed a high-density shadow of both lungs, atelectasis of right middle lobe, multiple enlarged lymph nodes in mediastinum and right hilum. Pathology of CT-guided percutaneous lung biopsy indicated fibrous tissue proliferation and granulation tissue formation and some alveolar epithelial cells slightly proliferated with focal carbon powder deposition in alveolar sacs and spaces. The lung tissue NGS confirmed Mycobacterium iranicum infection. CONCLUSIONS: Elevated serum G-lipopolysaccharide is not a specific index for infectious diseases. CT-guided percutaneous lung biopsy and lung tissue NGS has high specificity in pathogen detection of infectious diseases.
Assuntos
Bronquiectasia/patologia , Infecções por Bactérias Gram-Negativas/diagnóstico , Hemoptise/diagnóstico , Lipopolissacarídeos/sangue , Pulmão/patologia , Infecções por Mycobacterium/diagnóstico , Idoso , Biópsia/métodos , Diagnóstico Diferencial , Erros de Diagnóstico , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Humanos , Pulmão/microbiologia , Masculino , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Pulmonary hamartoma is one of the most common benign tumors of the lung, the symptoms are often atypical, so its diagnosis is not so easy. We presented an elderly man with elevated D-dimer combined persistent acupuncture-like chest pain misdiagnosed as pulmonary embolism finally proved as lung hamartoma with secondary lung infection by bronchoscopy biopsy. METHODS: Appropriate laboratory tests were carried out. The chest computed tomography (CT) scan and bronchoscopy were performed for diagnosis. RESULTS: Laboratory tests showed D-dimer was 2,615.88 ng/mL, the chest CT scan showed the right lung portal occupying lesions accompanied by obstructive changes in the middle of the right lung and mediastinal lymphade-nopathy with partial calcification. Bronchoscopy showed the new spherical neoplasm in the middle of the right lung completely blocked the opening of the bronchus, the surface of the neoplasm was smooth and blood vessels were abundant, pathological result was lung hamartoma. CONCLUSIONS: Elevated D-dimer is not a specific index of pulmonary embolism. When a patient's D-dimer rise combined with severe chest pain, the physician should be wary of pulmonary embolism, myocardial infarction, aortic dissection, and other emergencies, and should also take into account serious infections, tumors, and other diseases. Diagnosis needs further related examination. Chest CT scan has guidance function, and when the chest CT scan suggests the occupying lesion, the pathology examination is the key to identify the benign tumor.
Assuntos
Dor no Peito/diagnóstico , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Hamartoma/diagnóstico , Neoplasias Pulmonares/diagnóstico , Embolia Pulmonar/diagnóstico , Infecções Respiratórias/diagnóstico , Idoso , Broncoscopia , Diagnóstico Diferencial , Erros de Diagnóstico , Humanos , MasculinoRESUMO
BACKGROUND: Tuberculosis is a common infectious disease in developing countries. Tuberculosis and sarcoidosis are difficult to differentiate. We presented an adult case with increased serum sedimentation and positive tuberculosis antibody combined with multiple pulmonary nodules in chest CT in a middle-aged patient firstly misdiagnosed as tuberculosis proved as sarcoidosis by CT guided percutaneous lung puncture biopsy. METHODS: Appropriate laboratory tests are carried out. The chest CT scan, bronchoscopy CT guided percutaneous lung puncture biopsy were performed for diagnosis. RESULTS: Serum sedimentation was increased and tuberculosis antibody was positive. The chest CT scan showed multiple pulmonary nodules in both lungs and multiple lymphadenopathy. The bronchoscopy demonstrated no abnormality. Pathology of CT guided percutaneous lung puncture biopsy showed non-caseous multiple granulomatous lesions and acid-fast staining was negative. CONCLUSIONS: When a patient has multiple pulmonary nodules and lymphadenopathy without obvious tuberculosis poisoning symptoms, physicians should pay attention to tuberculosis, sarcoidosis, and lung cancer. Pathology is crucial for the ultimate diagnosis.
Assuntos
Anticorpos Antibacterianos/sangue , Nódulos Pulmonares Múltiplos/diagnóstico , Sarcoidose/diagnóstico , Tuberculose/diagnóstico , Anticorpos Antibacterianos/imunologia , Biópsia por Agulha/métodos , Sedimentação Sanguínea , Diagnóstico Diferencial , Erros de Diagnóstico , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Tuberculose/microbiologiaRESUMO
BACKGROUND: We report an invasive pulmonary aspergillosis (IPA) with negative (1,3)-ß-D-glucan and dynamically elevated white blood cells combined with procalcitonin proven by bronchoalveolar lavage fluid (BALF) culture. METHODS: Appropriate laboratory tests are carried out. Chest CTs were performed to assess the lungs. The cause of infection was determined using BALF culture. RESULTS: Serum (1,3)-ß-D-glucan was negative, white blood cells and procalcitonin were significantly higher than normal. The bronchoscopy revealed obvious necrotic detritus and pseudo membrane in the trachea, left and right main bronchi, and branches. BALF culture revealed the presence of Aspergillus. CONCLUSIONS: Negative (1,3)-ß-D-glucan is not safe to rule out invasive pulmonary aspergillosis. BALF culture is critical for IPA diagnosis.
Assuntos
Líquido da Lavagem Broncoalveolar/microbiologia , Complicações do Diabetes/diagnóstico , Aspergilose Pulmonar Invasiva/diagnóstico , Pneumonia/diagnóstico , Pró-Calcitonina/sangue , beta-Glucanas/sangue , Aspergillus/isolamento & purificação , Aspergillus/fisiologia , Complicações do Diabetes/sangue , Complicações do Diabetes/microbiologia , Diagnóstico Diferencial , Humanos , Aspergilose Pulmonar Invasiva/complicações , Aspergilose Pulmonar Invasiva/microbiologia , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Pneumonia/complicações , Pneumonia/microbiologia , ProteoglicanasRESUMO
BACKGROUND: Foreign body aspiration is a rare entity in adults. We presented an adult case with recurrent pulmonary infection firstly misdiagnosed as tuberculosis, which proved as foreign body aspiration in the left main stem bronchus by bronchoscopy. METHODS: Appropriate laboratory tests are carried out. The chest CT scan and bronchoscopy were performed for diagnosis. RESULTS: Serum sedimentation was increased and tuberculosis antibody was positive. The chest CT scan showed left lung consolidation and small pleural exudate on the left side. Significant calcification can be seen near the left main bronchus. The bronchoscopy demonstrated plenty of yellow sputum in left main bronchus and a peanut shell completely obstructed the left main bronchus and peripheral granulation tissue hyperplasia. The peanut shell was removed and the left main trachea was unobstructed. CONCLUSIONS: When a patient has recurrent pulmonary infection, especially at the same site, physicians should pay attention to airway obstruction caused by foreign body, cancer and other causes of airway stenosis. Bronchoscopy is crucial for the ultimate diagnosis.
Assuntos
Sedimentação Sanguínea , Erros de Diagnóstico , Corpos Estranhos/diagnóstico , Pulmão/diagnóstico por imagem , Mycobacterium tuberculosis/imunologia , Tuberculose/diagnóstico , Idoso , Anticorpos Antibacterianos/sangue , Anticorpos Antibacterianos/imunologia , Brônquios/microbiologia , Brônquios/patologia , Broncoscopia , Humanos , Pulmão/microbiologia , Masculino , Mycobacterium tuberculosis/fisiologia , Tomografia Computadorizada por Raios X , Traqueia/microbiologia , Traqueia/patologia , Tuberculose/sangue , Tuberculose/microbiologiaRESUMO
BACKGROUND: Detection of serum neuron specific enolase (NSE) has high sensitivity and specificity in the diagnosis of lung carcinoma, especially in small cell lung carcinoma, but sometimes serum NSE provided limited help. We report a case of a patient with right lung consolidation combined with elevated serum neuron specific enolase which mimicked lung carcinoma and was ultimately confirmed as pulmonary cryptococcosis by CT-guided percutaneous lung biopsy. METHODS: Chest computed tomography (CT) scan and CT-guided percutaneous lung biopsy were performed for diagnosis and blood tests explored the latent etiology. RESULTS: The chest CT scan showed right lung consolidation and a pulmonary nodule in lingual segment of upper lobe of left (Figure1A - F). Serum cryptococcal antigen was positive. Pathology of CT-guided percutaneous lung biopsy confirmed pulmonary cryptococcosis (Figure 1G - I). CONCLUSIONS: Elevated NSE is not a specific index of lung cancer. Serum cryptococcal antigen and CT-guided percutaneous lung biopsy has high specificity in cryptococcal pneumonia.
Assuntos
Criptococose/diagnóstico , Erros de Diagnóstico , Neoplasias Pulmonares/diagnóstico , Fosfopiruvato Hidratase/sangue , Biópsia/métodos , Criptococose/microbiologia , Humanos , Pulmão/microbiologia , Pulmão/patologia , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/microbiologia , Neoplasias Pulmonares/microbiologia , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Detection of carcinoembryonic Antigen (CEA) in pleural effusion has good clinical application value in differentiating benign and malignant pleural effusion, but sometimes CEA provides limited help. We report a case of a patient with left lung neoplasms combined with bilateral pleural effusion with increased CEA in the pleural effusion whose thoracoscopy pleural biopsy pathology was negative, mimicking lung carcinoma and ultimately confirmed as pulmonary sarcomatoid carcinoma by CT-guided percutaneous lung biopsy. METHODS: The chest computed tomography (CT) scan, thoracoscopy pleural biopsy, and CT-guided percutaneous lung biopsy were arranged to explore the etiology of pleural effusion. RESULTS: The chest CT scan showed bilateral pleural effusion with left lung neoplasms, pulmonary atelectasis, and left hilar enlargement. Pathology of thoracoscopy biopsy showed pleural inflammation with infiltration of inflammatory cells. Pathology of CT-guided percutaneous lung biopsy confirmed pulmonary sarcomatoid carcinoma. CONCLUSIONS: Elevated pleural effusion CEA is not a specific index of lung cancer. CT-guided percutaneous lung biopsy is appropriate for patients presenting with pleural diseases with lung neoplasms, especially when thoracoscopy pleural biopsy result was negative.
Assuntos
Antígeno Carcinoembrionário/metabolismo , Carcinoma/diagnóstico , Erros de Diagnóstico , Neoplasias Pulmonares/diagnóstico , Pleura/metabolismo , Derrame Pleural/diagnóstico , Idoso , Biópsia , Carcinoma/diagnóstico por imagem , Carcinoma/metabolismo , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pleura/diagnóstico por imagem , Pleura/patologia , Derrame Pleural/metabolismo , Derrame Pleural/patologia , Toracoscopia/métodos , Tomógrafos ComputadorizadosRESUMO
BACKGROUND: We report an acute pulmonary embolism with negative D-dimer masquerading as right pneumonia with pleural effusion proven by CT pulmonary arteriography (CTPA). METHODS: Appropriate laboratory tests are carried out. The application of vascular ultrasound for the cause of left lower extremity edema. CTPA were performed when vascular ultrasound suggested the existence of venous thrombosis of left lower extremity. RESULTS: Serum D-dimer was negative. Vascular ultrasound revealed left lower extremity venous thrombosis, CTPA demonstrated large emboli in the main pulmonary artery and main pulmonary artery branches. CONCLUSIONS: Negative serum D-dimer is not safe to rule out acute pulmonary embolism. When CT shows peripheral triangle-shaped infiltrate with pleuritis or small pleural exudate, physicians should pay attention to pulmonary infarction.
Assuntos
Angiografia/métodos , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Derrame Pleural/diagnóstico por imagem , Pneumonia/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Doença Aguda , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural/complicações , Pneumonia/complicações , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: We report a case that presented as fever with positive Epstein-Barr Virus (EBV) IgM antibody combined with subcutaneous nodules on lower extremities and cervical lymphadenopathy firstly misdiagnosed as infectious mononucleosis, which was proven as subcutaneous panniculitis-like T-cell lymphoma by subcutaneous nodule biopsies. METHODS: Appropriate serum and bacteriological laboratory tests were carried out for the cause of fever. An ultrasound and subcutaneous nodule biopsies were performed. RESULTS: EBV IgM antibody was positive. An ultrasound revealed multiple subcutaneous nodules, which were prone to be lipoma on lower extremities and cervical lymphadenopathy. Subcutaneous nodule biopsies were firstly misdiagnosed as lipoma, while pathology consultation for the subcutaneous nodule biopsies diagnosed subcutaneous panniculitis-like T-cell lymphoma. CONCLUSIONS: When patients have persistent fever with positive EBV IgM antibody combined other system involvements, especially lymphadenopathy and multiple subcutaneous nodules, it should differentiate lymphoma from infectious diseases.
Assuntos
Febre/diagnóstico , Imunoglobulina M/imunologia , Mononucleose Infecciosa/diagnóstico , Extremidade Inferior/patologia , Linfadenopatia/diagnóstico , Linfoma de Células T/diagnóstico , Paniculite/diagnóstico , Tela Subcutânea/patologia , Adulto , Anticorpos Antivirais/imunologia , Biópsia , Diagnóstico Diferencial , Feminino , Febre/etiologia , Herpesvirus Humano 4/imunologia , Herpesvirus Humano 4/fisiologia , Humanos , Mononucleose Infecciosa/complicações , Mononucleose Infecciosa/virologia , Extremidade Inferior/virologia , Linfadenopatia/etiologia , Linfoma de Células T/complicações , Pescoço , Paniculite/complicações , Encaminhamento e Consulta , Tela Subcutânea/virologiaRESUMO
BACKGROUND: Anemia combined with increased serum sedimentation (ESR) can be secondary to many diseases and may be ignored when the patient had few clinical symptoms. We report a case of persistent anemia combined with ESR for more than 2 years firstly misdiagnosed as lymphoma. When she received a chest CT scan multiple enlarged lymph nodes were found. METHODS: The chest contrast-enhanced CT scan and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the right hilum enlarged lymph nodes were performed for diagnosis. RESULTS: The chest CT scan and EBUS showed multiple enlarged right hilum and mediastinum lymph nodes without calcification. Pathology of EBUS-TBNA showed multiple granulomas; Zeihl-Neelsen acid-fast stain was positive. CONCLUSIONS: Systemic lymph node tuberculosis is rarely seen in adult patients. In a young patient who has anemia combined with increased ESR should be excluded if those changes are secondary to tuberculosis.
Assuntos
Tuberculose dos Linfonodos/diagnóstico por imagem , Adulto , Anemia/etiologia , Sedimentação Sanguínea , Broncoscopia , Erros de Diagnóstico , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Feminino , Humanos , Linfoma/diagnóstico , Tuberculose dos Linfonodos/sangue , Tuberculose dos Linfonodos/complicaçõesRESUMO
BACKGROUND: High serum neuron-specific enolase (NSE) level has been in use as a tumor marker; however, some physicians may ignore NSE levels in serum, especially when the patients are asymptomatic. Here we report a case that a 51 year old female patient with no respiratory symptoms who had a NSE level which increased extremely over three months and was eventually diagnosed small cell lung cancer (SCLC). METHODS: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in right pulmonary hilar enlarged lymph node was performed for diagnosis. RESULTS: EBUS showed right pulmonary hilar lymph node enlargement. A TBNA biopsy histopathology diagnosed SCLC. CONCLUSIONS: We should pay attention to high serum NSE levels, especially when the index increased extremely over a short time.
Assuntos
Biomarcadores Tumorais/sangue , Neoplasias Pulmonares/sangue , Fosfopiruvato Hidratase/sangue , Carcinoma de Pequenas Células do Pulmão/sangue , Feminino , Humanos , Pulmão/patologia , Neoplasias Pulmonares/diagnóstico , Linfonodos/patologia , Pessoa de Meia-Idade , Carcinoma de Pequenas Células do Pulmão/diagnósticoRESUMO
Background: To report an atypical case misdiagnosed as lung abscess over the past 2 months, but persistent anemia combined with significantly increased hs-CRP and lung lesions indicated systemic lesion, which led to the diagnosis of granulomatosis with polyangiitis proven by lung biopsy and anti-neutrophil cytoplasmic antibody test (ANCA).
Methods: The complete blood count, hs-CRP, and anti-neutrophil cytoplasmic antibody (ANCA) test were performed. The pathology consultation for the lung biopsy was arranged.
Results: Hemoglobin was 8.5 g/L, hs-CRP was > 200 mg/L, c-ANCA directed against anti-proteinase 3 (PR3) was positive, pathology consultation reported granulomatous inflammation.
Conclusions: When patients have multiple organ dysfunction combined with anemia and significantly increased hs-CRP, physicians should pay attention to systemic vasculitis.
.Assuntos
Anemia/sangue , Anticorpos Anticitoplasma de Neutrófilos/análise , Proteína C-Reativa/análise , Granulomatose com Poliangiite/diagnóstico , Pulmão/patologia , Anticorpos Anticitoplasma de Neutrófilos/sangue , Biópsia , Diagnóstico Diferencial , Feminino , Granulomatose com Poliangiite/sangue , Humanos , Pessoa de Meia-IdadeRESUMO
BACKGROUND: To report a case of broncholithiasis with recurrent hemoptysis and fever initially misdiagnosed as active tuberculosis. METHODS: The chest contrast-enhanced CT scan, electronic bronchoscope, and ultrathin bronchoscope were performed leading to the diagnosis of broncholithiasis, open lung lobectomy was done after thoracic surgery consultation. RESULTS: The chest contrast-enhanced CT scan showed a high-density intratracheal shadow and calcified lymph nodes. Ultrathin bronchoscopy manifested calcified lesions located at the distal portion of the right lower lobe bronchus. Histopathology of lobectomy showed lithiasis in the right lower lobe tracheobronchial tree. CONCLUSIONS: We should pay attention to calcified intratracheal lesions and make differential diagnosis with tuberculosis, especially when accompanied with calcified lymph nodes and fever.
Assuntos
Broncopatias/diagnóstico , Febre/complicações , Hemoptise/complicações , Litíase/diagnóstico , Tuberculose Pulmonar/diagnóstico , Tuberculose/diagnóstico , Adulto , Broncopatias/complicações , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Febre/patologia , Hemoptise/patologia , Humanos , Litíase/complicações , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/cirurgia , Procedimentos Cirúrgicos Pulmonares , Recidiva , Tomografia Computadorizada por Raios XRESUMO
Background: Cryptococcal pneumonia is an uncommon lesion in immune-competent adults. Histological evidence of Cryptococcus neoformans is a gold criterion for diagnosis. Here we report a case firstly misdiagnosed as tuberculosis from a lung biopsy. Methods: Chest computed tomography (CT) scan and CT-guided puncture were performed for diagnosis and blood tests explored for the latent etiology. Results: Chest CT scan images showed multiple nodules in the left peripheral lower lobe. Histopathology demonstrated multiple granulomatous inflammatory response lacking evidence of Cryptococcus neoformans, acid-fast staining was negative, serum cryptococcal antigen was positive. Conclusions: Serum cryptococcal antigen has high specificity in cryptococcal pneumonia.
Assuntos
Antígenos de Fungos/sangue , Criptococose/diagnóstico , Cryptococcus neoformans/imunologia , Pneumopatias Fúngicas/diagnóstico , Tuberculose Pulmonar/diagnóstico , Adulto , Biópsia , Criptococose/sangue , Criptococose/microbiologia , Cryptococcus neoformans/fisiologia , Erros de Diagnóstico , Humanos , Pulmão/diagnóstico por imagem , Pulmão/microbiologia , Pulmão/patologia , Pneumopatias Fúngicas/sangue , Pneumopatias Fúngicas/microbiologia , Masculino , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/microbiologia , Tuberculose Pulmonar/patologiaRESUMO
Background: Tracheobronchopathia osteochondroplastica (TO) is a rare benign disease. We report a case of TO. Methods: Chest CT scan and bronchoscope with biopsy was performed for diagnosis and blood tests explored for the latent etiology. Results: Chest CT scan and bronchoscopic images showed multiple nodular protrusions in the trachea and main bronchi. Histopathology demonstrated sub-mucosal ossification and inflammatory cell infiltration. Laboratory inspection showed adenovirus and coxsackie B virus IgM antibodies were positive. Conclusions: The patient recently had a virus infection and inflammation was observed in histopathology, which indicated adenovirus and coxsackie B virus may play a role in the occurrence or exacerbation of TO.