老年间质性肺炎误诊为慢性支气管炎的原因分析及影像学特征OA

Objective To investigate the causes of misdiagnosis of interstitial pneumonia(IP)in the elderly as chronic bronchitis(CB)and the imaging characteristics.Methods A retrospective analysis was conducted on the clinical data of 2 elderly patients who were misdiagnosed as having CB instead of IP during the period from January 2020 to June 2023.Results One patient presented with recurrent cough,white sputum expectoration,and shortness of breath.Chest X-ray showed increased pulmonary markings in both lungs.The initial diagnosis was acute exacerbation of CB,and symptomatic treatment was given for 2 weeks.However,the symptoms did not improve and shortness of breath worsened.Further high-resolution CT(HRCT)revealed grid shadows in the lower lungs and honeycomb-like changes under the pleura.Pulmonary function tests indicated restrictive ventilation disorder,and elevated serum sialic acid glycan antigen-6 level.The final diagnosis was IP in the elderly(idiopathic pulmonary fibrosis type).The misdiagnosis period was 2 weeks.Nintedanib for anti-fibrotic treatment and long-term home oxygen therapy were administered.Follow-up for 6 months showed stable condition.Another patient presented with post-exercise breathing difficulty and dry cough,with a history of Sjögren's syndrome.Pulmonary function tests showed mild obstructive changes.The initial diagnosis was CB,and symptomatic treatment was given for 1 month,but the symptoms did not improve.HRCT showed diffuse ground-glass opacities in both lungs with traction bronchiectasis.Anti-nuclear antibody was positive(at a titer of 1∶320),and the diagnosis was IP in the elderly(Sjögren's syndrome-related IP).The misdiagnosis period was 1 month.Prednisone combined with Cyclophosphamide was used for treatment,and the patient was followed up for 1 year.The patient's condition remained stable.Conclusions The clinical manifestations of IP in the elderly are prone to confusion with those of CB.In clinical practice,a comprehensive analysis involving HRCT,pulmonary function tests,and serological markers is necessary to avoid misdiagnosis solely relying on chest X-rays or pulmonary function tests.