- 期刊
Endobronchial Ultrasonography (EBUS) to Differentiate Tuberculoma from Lung Cancer-A Case Report and Literature Review
應用支氣管鏡超音波鑑診斷肺癌與肺結核－病例報告與文獻回顧
摘要
同時存在肺癌和肺結核在台灣並非不常見，所以對於臨床醫師而言，決定肺部腫瘤的本質對於診斷和治療是很重要的。只使用支氣管鏡來診斷周邊肺部異常病灶，診斷率是受限的。然而、使用支氣管內超音波能更準確的定位肺部周邊異常的病灶並且增加診斷率。而且支氣管鏡超音波的影像也能幫忙鑑別診斷惡性與良性的病灶。在一位同時具有肺癌以及肺結核的六十七歲男性，在不同的肺葉分別發現兩個肺部腫瘤。支氣管鏡超音波在右中葉的病灶發現的影像是不均勻並有連續性高回響的邊緣，而在左上葉的病灶則是高回響的影像點以及沒有連續性高回響的邊緣。這兩種型態分別代表著惡性與良性。病理檢驗與肺結核茵的培養分別證實診斷右中葉的肺癌以及左上葉的肺結核。我們回顧了肺癌和肺結核同時並存之致病因以及支氣管鏡超音波對於肺部周邊病灶的影像特徵與輔助診斷之相關文獻報告。
並列摘要
The coexistence of lung cancer and pulmonary tuberculosis is not uncommon in Taiwan, so determining the nature of a lung mass is critically important for physicians, in order to reach a definite diagnosis and therapy. The diagnostic yield of the peripheral lung abnormality using bronchoscopy alone is limited; however, the development of miniature probes and endobronchial ultrasonography (EBUS) has improved the accurate localization of peripheral lung lesions and the diagnostic rates. Furthermore, EBUS images are also helpful in differentiating between benign and malignant lung abnormalities. EBUS detected a heterogeneous mass with continuous hyperechoic margin in the right middle lobe and another mass with hyperechoic dots and discontinuous hyperechoic margin in the left upper lobe of a 67-year-old man with coexisting lung adenocarcinoma and pulmonary tuberculoma, who presented 2 lung masses in different lobes. The 2 image patterns suggested malignant versus benign lung abnormalities of the 2 masses, respectively, which were confirmed by the pathologic and bacteriologic studies. The literature concerning the coexistence of lung cancer and tuberculosis and the imaging characteristics of EBUS in lung abnormalities are reviewed.