模拟气道肿瘤的支气管结核罕见表现：一例病例报告及文献复习

文献信息

中文摘要

背景： 支气管结核是肺结核的一种特殊类型，由于其非特异性的临床和影像学表现，给诊断带来了重大挑战。支气管结核的肿瘤型亚型尤为罕见，其临床病程多变，并存在气道狭窄的风险。方法：一名21岁男性因急性起病的咳嗽、胸闷和发热就诊。胸部CT显示左主支气管和左上叶支气管内有一个巨大的阻塞性支气管内肿块，最初被误诊为气道肿瘤。鉴于严重的气道阻塞，患者接受了支气管镜下支气管内肿块切除术，以明确诊断并缓解症状。结果：切除肿块的病理组织学分析及支气管肺泡灌洗液的分子检测证实为肿瘤型支气管结核合并浸润性肺结核。患者接受了根据支气管镜检查结果制定的个体化抗结核治疗，随访胸部CT显示病灶明显消退，无支气管狭窄等并发症。结论：肿瘤型支气管结核是一种不寻常、易被误诊的亚型，预后可能严重，在支气管内肿块的鉴别诊断中必须仔细考虑。及时诊断和早期启动抗结核治疗对于实现无并发症的愈合至关重要，正如该患者良好的转归所证明的那样。

英文摘要

Tracheobronchial tuberculosis is a special type of pulmonary tuberculosis that poses significant diagnostic challenges due to its nonspecific clinical and radiological manifestations. The tumorous subtype of tracheobronchial tuberculosis is particularly rare and carries a variable clinical course with risk of airway stenosis. A 21-year-old male presented with acute-onset cough, chest tightness, and fever. Chest CT revealed a large obstructive endobronchial mass in the left main bronchus and left upper lobe bronchus, initially misdiagnosed as an airway tumor. Given the severe airway obstruction, the patient underwent bronchoscopic resection of the endobronchial mass for diagnosis and symptom relief. Histopathological analysis of the resected mass and molecular testing of bronchoalveolar lavage fluid confirmed tumorous tracheobronchial tuberculosis complicated with infiltrative pulmonary tuberculosis. The patient received individualized anti-tuberculosis therapy tailored to bronchoscopic findings, and follow-up chest CT showed marked lesion regression without complications such as bronchial stenosis. Tumorous tracheobronchial tuberculosis is an unusual, easily misdiagnosed subtype with a potentially severe prognosis, and it must be carefully considered in the differential diagnosis of endobronchial masses. Timely diagnosis and early initiation of anti-tuberculosis therapy are critical for achieving uncomplicated healing, as demonstrated by this patient's favorable outcome.