中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

纤维性纵隔炎一例并文献复习

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目的探讨国内纤维性纵隔炎的病因、临床表现、CT 表现、病理特点、诊断与鉴别诊断、治疗。方法回顾性分析武警四川省总队医院呼吸内科收治的 1 例纤维性纵隔炎患者的临床资料并进行相关文献复习。以“纤维性纵隔炎”、“纤维化纵隔炎”、“纤维素性纵隔炎”、“纵隔纤维化”、“硬化性纵隔炎”、“慢性纵隔炎”为检索词检索万方数据库和中国期刊网全文数据库,以“fibrous mediastinitis”、“mediastinal fibrosis”、“fibrosis of mediastinum”、“fibrosing mediastinitis”、“sclerosing mediastinitis”、“chronic mediastinitis”为检索词检索 PubMed 数据库,检索时间为 1980 年 1 月至 2016 年 12 月。结果本例为 59 岁男性,胸部 CT 提示肺门、纵隔见增多软组织密度影,肺门多发支气管截断,肺动脉于肺门处局部明显狭窄。在以上数据库检索到 12 篇 37 例国内纤维性纵隔炎病例。15 例考虑与结核感染有关,9 例为特发性纵隔纤维化。就诊常见症状有咳嗽、呼吸困难、胸闷、胸痛、发热、浮肿。CT 提示纵隔和肺门软组织密度影,弥漫性分布 32 例,累及气管支气管 26 例,累及肺动脉 29 例,累及肺静脉 13 例,胸腔积液 16 例,累及腔静脉或其分支 8 例。18 例描述其他部位受累情况,其中累及主动脉或其分支 4 例,累及食管 1 例,心包积液 6 例。14 例有病理结果。结论国内纤维性纵隔炎最常见的病因是结核感染,其次为特发性纵隔纤维化。临床症状无特异性。CT 表现为纵隔和肺门软组织密度影,弥漫性分布为主,包绕纵隔和肺门内气道、食道及血管,可累及心包、胸膜。病理特点为纤维组织增生,伴淋巴细胞增生,病变无包膜。其诊断主要依靠 CT 和病理。特发性纵隔炎可考虑糖皮质激素治疗,手术和血管介入治疗可改善纵隔内血管受压症状。

ObjectiveTo explore the etiology, clinical manifestation, computed tomography (CT) manifestations, pathological character, diagnosis, differential diagnosis, and treatment of fibrous mediastinitis in China.MethodsThe clinical data of a patient with fibrous mediastinitis admitted to Hospital of Sichuan Provincial Armed Police Force were retrospectively analyzed and the related literature was reviewed. A literature research was performed with " fibrous mediastinitis, mediastinal fibrosis, sclerosing mediastinitis, chronic mediastinitis ”as the Chinese key word in WanFang database and China national knowledge internet, and " fibrous mediastinitis, mediastinal fibrosis, fibrosis of mediastinum, fibrosing mediastinitis, sclerosing mediastinitis, chronic mediastinitis” as English key words in PubMed database. The time interval was from January 1980 to December 2016.ResultsThe patient was a 59 year old male, whose chest CT scan showed soft tissue density in pulmonary hilar and mediastina, with bronchus truncation and obvious stenosis of pulmonary artery in hilar. Literature review found 12 related articles reporting 37 cases of fibrous mediastinitis in China. Fifteen cases were caused by tuberculosis infection presumably, and 9 cases were idiopathic mediastinal fibrosis. The common clinical manifestations were cough, dyspnea, chest tightness and pain, fever, and edema. CT manifested soft tissue density in pulmonary hilar and mediastina, which were diffuse in 32 cases. Trachea and bronchus were involved in 26 cases, while pulmonary artery in 29 cases, pulmonary vein in 13 cases, plural effusion in 16 cases, and vena cava and its branch in 8 cases. Other involved regions were described in 18 cases, including aorta and its branch in 4 cases, esophagus in 1 case, and there were pericardial effusion in 6 cases. Fourteen cases had pathology results.ConclusionsThe most common etiological factor of fibrous mediastinitis in China is tuberculosis infection, secondly idiopathic mediastinal fibrosis. Clinical manifestation is nonspecific. mostly diffuse, surrounding bronchus, esophagus and blood vessels in hilar and mediastina, and sometimes infiltrating into pericardium and pleurae. Its pathological character is proliferation of fibrous tissue, with proliferation of lymphocytes, and without envelope. The diagnosis depends on CT and pathology. Corticosteroid is considered to treat idiopathic mediastinal fibrosis, while surgery and vascular interventional therapy may improve symptoms of vascular compression in mediastina.

关键词: 纵隔炎; X 射线计算机断层成像; 病理; 诊断

Key words: Mediastinitis; Tomography, X-Ray Computed; Pathology; Diagnosis

引用本文: 王雅敏, 江国强. 纤维性纵隔炎一例并文献复习. 中国呼吸与危重监护杂志, 2018, 17(6): 593-598. doi: 10.7507/1671-6205.201709037 复制

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