Multiple Pulmonary Nodules: A Diagnostic Dilemma in an Endemic Area for Tuberculosis

多發性肺結節：肺結核盛行區域的診斷困境－病例報告

郭耀文(Yao-Wen Kuo) ； 王鶴健(Hao-Chien Wang) ； 余忠仁(Chong-Jen Yu)

《胸腔醫學》 24卷6期 (2009/12) Pp. 315-319

https://doi.org/10.29806/TM.200912.0002

摘要

台灣是肺結核的盛行區域，而肺癌亦是國人的主要死因之一；當病人同時得到肺癌及肺結核感染時，其診斷及治療都極具挑戰性；我們報告一名60歲女性患者，體檢意外發現肺部有7個多發性肺結節，其中左下肺的結節在經電腦斷層導引之穿刺組織切片後，病理報告呈現乳酪化狀的肉芽腫；在投予抗結核菌治療三個月後，肺結節有縮小的趨勢，但後續胸腔X光檢查發現二側肺野的結節增大而且併有粟粒狀的病變，其中右下的肺結節在支氣管鏡超音波導引之穿刺組織切片下呈現肺腺癌；在多發性肺結節中，不同的結節可能有著不同的致病機轉，因此密切追蹤治療反應及保持高度的臨床警覺十分重要。

關鍵字

多發肺結節 ； 肺結核 ； 肺腺癌

並列摘要

In Taiwan, which is an endemic area for tuberculosis, coexisting pulmonary tuberculosis and lung cancer may pose both a diagnostic and a treatment challenge to the clinician. We present the case of a 60-year-old female with multiple pulmonary nodules. The initial diagnosis of pulmonary tuberculosis was made by the pathological finding of a left lower lung nodule. The initial treatment response was fair, before a 3-month gap in follow-up. However, miliary carcinomatosis developed later and tissue proof of a right lower lung nodule revealed adenocarcinoma. When encountering a patient with multiple pulmonary nodules in an endemic area for tuberculosis, the possibility of a coexisting etiology other than tuberculosis should always be kept in mind; close monitoring of the treatment response is mandatory.

並列關鍵字

multiple pulmonary nodules ； pulmonary tuberculosis ； adenocarcinoma of lung