非结核分枝杆菌肺病误诊原因分析OA

Objective To analyze the causes of misdiagnosis in non-tuberculous mycobacterial pulmonary disease(NTM-PD),and to summarize its high-resolution computed tomography(HRCT)imaging features and diagnostic process in detail,so as to investigate effective strategies to reduce misdiagnosis.Methods A retrospective analysis was conducted on the clinical manifestations,imaging features,and treatment process of 2 patients with NTM-PD who were misdiagnosed from January to June 2023.Results One patient presented with repeated hemoptysis for over 20 years,with a recurrence for 1 d.The patient coughed up approximately 2 mL of blood,with occasional cough,and no other obvious symptoms such as fever.The patient had a history of pulmonary tuberculosis and was diagnosed with secondary pulmonary tuberculosis 3 years ago.Antituberculosis treatment was received,but the symptoms did not show significant improvement.Chest HRCT showed bronchiectasis in the upper lobes of both lungs with small nodules and cavitary lesions.The macrogenomic next-generation sequencing(mNGS)of bronchial alveolar lavage fluid detected infection by the Mycobacterium avium-intracellulare complex(MAC).Based on the clinical symptoms,imaging findings,and pathogenological examination,the final diagnosis was NTM-PD.The misdiagnosis lasted for 3 years and 3 months.At 5 d after symptomatic treatment,the hemoptysis symptoms disappeared,and the patient's condition improved.The patient continued to take medication after discharge,and a follow-up examination at 1 month after discharge showed a good prognosis.One patient presented with coughing,expectoration,and blood in sputum for over 5 months.The patient developed coughing and white sticky sputum after catching a cold,accompanied by intermittent blood in sputum,without symptoms such as fever or night sweats.Multiple chest CT scans and puncture biopsies were performed,but no cancer cells were found.Positron emission tomography-computed tomography(PET-CT)suggested right upper lobe lung cancer with multiple metastases,but the pathological results did not show any evidence of malignancy.HRCT showed right upper lobe consolidation,bronchial stenosis,and multiple enlarged lymph nodes.It was preliminarily considered as infectious lesions or tumors.After mNGS of bronchoalveolar lavage fluid confirmed MAC infection,and the diagnosis was mainly consolidation-dominant NTM-PD.The misdiagnosis period was 3.5 months.The treatment plan was adjusted to combined anti-nontuberculous mycobacterial treatment.At 1 week after treatment,the symptoms improved.At the 6-month follow-up,the symptoms basically disappeared,the lesion significantly shrank but there was residual fibrosis.Conclusion NTM-PD is prone to misdiagnosis due to its clinical manifestations and imaging features being similar to various lung diseases.Early combination of HRCT imaging features and microbiological examination is the key to diagnosis.