■继发于非典型结节病(结节病的非典型表现)的纤维性纵隔炎(FM)在国内外鲜有报道。其临床表现表现为缺乏特异性,最初的诊断往往很困难。特别是,此例肺部多发结节伴纵隔淋巴结肿大和双侧胸腔积液,治疗后肺纤维化仍然存在,这与肺结节病的任何临床阶段都不一致,进一步增加了诊断难度。回顾性分析重庆大学涪陵医院1例经支气管超声引导烧灼辅助经支气管纵隔冷冻活检(EBUS-CA-TBMCB)诊断为不典型结节病继发FM的临床资料,提高临床医生对FM的重视,并了解EBUS-CA-TBMCB仍然是病因诊断的有效方法。
■一名70岁男子因咳嗽和呼吸困难住院两个月。入院后,通过胸部计算机断层扫描(CT),超声引导下双侧肺活检,左顶叶胸膜活检,和EBUS-CA-TBMCB,最终诊断为非典型结节病继发FM。口服糖皮质激素后,病人的病情明显改善,出院了.我们继续在医院外跟进,患者病情进一步好转。
■FM的诊断主要基于典型的影像学表现。当对比增强胸部CT发现纵隔和肺门周围有不规则形状的局部或弥漫性软组织密度阴影时,有或没有钙化,应特别注意排除FM。EBUS-CA-TBMCB,作为一种改进的微创方法,可以获得足够的组织样本进行病理诊断,这可能是FM病因的有效活检方法,以避免将来的漏诊和误诊。
UNASSIGNED: Fibrosing mediastinitis (FM) secondary to atypical sarcoidosis (atypical presentation of sarcoidosis) is rarely reported at home and abroad. Its clinical manifestations represent a lack of specificity, and the initial diagnosis is frequently difficult. In particular, this case has multiple pulmonary nodules with mediastinal lymph node enlargement and bilateral pleural effusion, and pulmonary fibrosis still exists after treatment, which is inconsistent with any clinical stage of pulmonary sarcoidosis, further increasing the diagnostic difficulty. We retrospectively analyzed the clinical data of a case of FM secondary to atypical sarcoidosis diagnosed by endobronchial ultrasound-guided cautery-assisted transbronchial mediastinal cryobiopsy (EBUS-CA-TBMCB) in Chongqing University Fuling Hospital, to improve clinicians\' attention to FM and understand that EBUS-CA-TBMCB remains an effective way of etiological diagnosis.
UNASSIGNED: A 70-year-old man was hospitalized with cough and dyspnea for two months. After admission, through chest computed tomography (CT), ultrasound guided bilateral lung biopsy, left parietal pleural biopsy, and EBUS-CA-TBMCB, the final diagnosis was atypical sarcoidosis secondary FM. After taking glucocorticoid orally, the patient\'s condition improved significantly, and was discharged from the hospital. We continued following up outside the hospital, and the patient\'s condition was further improved.
UNASSIGNED: The diagnosis of FM is mainly based on typical imaging manifestations. When the contrast-enhanced chest CT finds localized or diffuse soft tissue density shadows around the mediastinum and pulmonary hilum with an irregular shape, with or without calcification, particular attention should be paid to exclude FM. EBUS-CA-TBMCB, as an improved minimally invasive method, can obtain enough tissue samples for pathological diagnosis, which may be the effective biopsy method for the etiology of FM to avoid missed diagnosis and misdiagnosis in the future.