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结节病四例诊治体会

目的 探讨结节病的临床特点和诊断方法。 方法 回顾性分析我院2012年4月至2015年9月经病理学确诊的4例结节病患者的临床及影像学资料。 结果 4例结节病患者中，男3例， 女1例，年龄23~70岁。3例患者临床表现为咳嗽、胸闷和气促，其中1例以腮腺肿大为主要表现；另1例无明显临床症状。胸部CT均显示肺门及纵隔淋巴结肿大。患者均经淋巴活检、腮腺外科活检。给予糖皮质激素治疗效果良好。 结论 结节病较少见，临床表现无特异性，临床易误诊。对肺门及纵隔淋巴结肿大病例，应尽早行病理学检查以明确诊断。结节病治疗首选糖皮质激素。

以多颅神经病变起病继发多器官受累的结节病一例

目的 报告1例多颅神经病变继发多器官受累的结节病患者的诊疗过程，结合国内外相关文献进行分析，加强临床医师对该疾病的认识及重视，提高早诊早治率，减少漏诊及误诊。方法 对1例多颅神经病变继发多器官受累的结节病患者的临床资料结合国内外文献进行分析和总结。结果 1例因“视物模糊、口角歪斜、长期咳嗽咳痰”多次入院的51岁女性患者，结合临床症状、体征、影像学特点及病理检查，诊断为结节病，治疗后随访症状好转。结论 对于临床上遇到多个系统症状短期内接连发生并因此多次住院患者，常规对症治疗效果不佳且病情仍在不断进展并排除其他相关疾病时，应考虑受累非典型系统的结节病可能，同时也为结节病的治疗提供临床策略。

结节病并发后葡萄膜炎一例

不典型胸部结节病影像诊断研究

结节病是一种原因未明的多系统肉芽肿性疾病，其特征是发生广泛的非干酪性上皮肉芽肿，可累及全身各个器官，90％可累及肺部[1]。其诊断依赖于组织学活检证实有非干酪性坏死性肉芽肿，且抗酸染色阴性，临床表现，以及影像学表现。由于组织学活检不易获得，且临床表现无特异性，故影像诊断则成为诊断该病的关键。影像学表现典型者，结节病的诊断较易，但也不乏误诊者；影像学表现不典型者，极易误诊。现回顾分析28例胸部结节病患者的相关资料，探讨结节病的影像诊断，尤其是不典型者的影像诊断，以提高结节病的诊断准确率。

结节病19 例临床分析

目的 探讨结节病的临床特点, 提高对结节病的认识及诊治水平。方法 对19 例经病理组织学检查确诊的结节病患者的临床资料进行分析。结果 发病年龄在32 ～65 岁, 40 岁以上患者占78. 9% , 女性多于男性。临床表现主要有咳嗽、咳痰、胸闷气短、体重下降、心脏受累、皮肤结节及红斑等。多数患者可见淋巴细胞计数减低, 胸部X 线分期以Ⅰ期和ⅡA 期多见, 皮肤活检、外周淋巴结活检以及支气管镜下活检阳性率较高。结论 结节病临床表现及各项检查无明显特异性, 应尽可能进行病理学检查并结合临床资料综合判断方能确诊。

Multiple Systemic Sarcoidosis Misdiagnosed as Lymphoma: One Case Report and Literature Review

ObjectiveTo improve the diagnosis and treatment of multiple systemic sarcoidosis (MSS) and avoid misdiagnosis. MethodsTo analyze the diagnosis and treatment of a MSS patient misdiagnosed as lymphoma. Related literatures were also reviewed. ResultsThe patients' clinical manifestations were not specific including cough and stethocatharsis. Lung and thoracic lymph nodes were most commonly involved in MSS. MSS was characterized by symmetrical lymph nodes enlargement in the bilateral lung hilus and/or mediastinum. The enlarged lymph nodes had a clear boundary and showed homogeneous enhancement. Symmetrical fluorodeoxyglucose (FDG) uptake in the hilar and/or mediastinal node was a typical finding of sarcoidosis on FDG PET/CT. Mucosal inflammation and mucosal nodules could be seen in the bronchoscope. Sarcoidosis was characterized by the presence of noncaseating groanulomas histologically. Hormonal therapy was effective for MSS. ConclusionSarcoidosis is a kind of disease involving multiple systems and organs with unknown etiology. The clinical manifestation of sarcoidosis is nonspecific,so it's likely to be misdiagnosed. Imaging examination and laboratory examination are helpful to the diagnosis of MSS. The definitive diagnosis depends on the pathologic biopsy.

结节病伴乳糜胸一例并文献复习

目的观察分析结节病伴乳糜胸的临床特征、诊断、治疗，以提高临床医生对该病的认识。方法分析南京医科大学第一附属医院病理确诊的首例结节病伴乳糜胸患者的临床资料，并检索复习 PubMed 的 10 例结节病伴乳糜胸患者的发病年龄、性别、临床表现、实验室检查、治疗和预后。结论本例为年轻男性患者，以胸痛、咳嗽为首发症状；胸部 CT 示全身多发淋巴结肿大，多发肺结节影，胸膜增厚，左侧胸腔积液及肺间质改变；胸腔闭式引流示乳糜胸；颈部淋巴结和支气管黏膜活检病理为非干酪样肉芽肿；经泼尼松治疗 9 个月预后佳。分析检索的 10 例结节病并发乳糜胸患者，以右侧乳糜胸为主，患者大多通过肺组织、淋巴结及胸膜活检确诊，治疗包括糖皮质激素、生长抑素、中链甘油三脂饮食、胸膜固定术及胸导管结扎术。对Ⅱ、Ⅲ期患者以糖皮质激素为基础的内科治疗大多数预后良好，Ⅳ期结节病伴并乳糜胸患者糖皮质激素治疗效果差，并发心肺功能不全可致死亡。结论乳糜胸是结节病的一种罕见并发症，与肉芽肿侵犯淋巴组织引起淋巴管阻塞有关，内科治疗大多预后好。

伴胸水的结节病一例报告

结节病性脉络膜肉芽肿一例

Sarcoidosis with pleural effusion as the initial manifestation: 4 case reports

Objective To investigate the clinical features, chest imaging manifestations, pathological changes, diagnosis and treatment of sarcoidosis with pleural effusion as the initial manifestation, and to analyze the possible causes of misdiagnosis, so as to help clinicians improve their understanding of sarcoidosis with pleural effusion as the initial manifestation, and reduce the rate of clinical misdiagnosis and missed diagnosis. Methods The general data, clinical manifestations, imaging examinations, pathological findings and outcomes of 4 patients with sarcoidosis with pleural effusion as the first manifestation admitted to Ningxia Medical University General Hospital from January 2019 to December 2020 were retrospectively analyzed. Results Out of these patients, 3 were female and 1 was male, with an average age of 50.3 years. The main clinical features were cough, expectoration, chest tightness, shortness of breath and other common respiratory symptoms. Chest CT indicated right pleural effusion. After admission, closed thoracic drainage, tracheoscopy, thoracoscopy, pleural biopsy and cervical lymph node biopsy were performed to obtain pathology. Combined with imaging and pathology, diagnosis was made. After hormone therapy, symptoms and imaging were improved. Conclusions Sarcoidity-related pleural effusion is relatively rare as the first episode, with no specific clinical symptoms and no specific physical and chemical properties of pleural effusion. Non-caseous granulomatous lesions can be found pathologically, and the diagnosis needs to rely on clinical, imaging and pathological comprehensive judgment.