This article introduces a case of a patient with spherical pneumonia with a CT appearance resembling a lung mass, so as to strengthen the consolidation of knowledge about spherical pneumonia, so as to avoid clinical misdiagnosis and mistreatment , reduce the unnecessary inspection and examination of patients, as well as the medical economic burden.
Author: Tian Jiawei, Department of Respiratory and Critical Care Medicine, Jiangyin People’s HospitalThis article is published by the author with the authorization of Yimaitong, please do not reprint without authorization.
Case introduction
The patient is a 47-year-old, middle-aged male, previously healthy, with fever for 4 days Hospitalized in our department. Four days ago, there was no obvious incentive for fever, the highest T39.0 ℃, accompanied by chills, nasal congestion and runny nose, and cough and sputum were not obvious. On physical examination, the breath sounds of both lungs were clear, and no obvious dry or wet rales were heard. The blood routine examination showed no abnormality, CRP78.1mg/l, CT (Figure 1) left upper lobe mass with peripheral obstructive pneumonia, and enhancement is recommended. Then he was admitted to the hospital with left upper lung pneumonia and left upper lung space-occupying. Fig. 1 The left upper lobe sees mass consolidation, about 3.3×4.2 cm in size, distal bronchus obstruction, and small plaques around the mass The adjacent pleura is thickened and stretched. When the receiving doctor has communicated with the patient’s family and the possibility of lung cancer is not ruled out, the director decided to consider spherical pneumonia after reading the ward round. Further examination of the full set of tumors after hospitalization showed no abnormality. Cefoxitin combined with levofloxacin was given for anti-infection 1 week later, and the mass was reduced in the re-examination. After re-examination at the outpatient clinic in January, the inflammatory lesions were significantly reduced and absorbed (Figure 2).
Figure 2 Left upper lobe inflammation and absorption stage (2022-04-03-19) and 2022-03-13) inflammatory lesions were significantly reduced.
Discussion
Spheroid pneumonia, an acute inflammation of the lungs that appears isolated on X-ray and CT Oval, round, wedge-shaped or square lesions. Because it is quite similar to spherical lung lesions such as peripheral lung cancer and tuberculosis, it is easy to cause misdiagnosis. Therefore, it is necessary to improve the understanding of spherical pneumonia. The mechanism of its formation may be related to the centrifugal and equidistant diffusion of inflammatory exudate from the lungs to the surrounding through the interalveolar pores, which presents a spherical outline. Statistical analysis by some researchers found that spherical pneumonia can occur in all lung lobes, and the dorsal segment of the lung lobe is mainly close to the pleura. “Vacuole sign”, “air bronchus sign”, “local congestion sign”, most lesions have pleural reaction, and the “square sign” or “knife cut sign” in which the lesions close to the pleura are at right angles to the chest wall (Fig. The second re-examination showed that the lesions obviously changed with the absorption of inflammation. Therefore, spherical pneumonia, peripheral lung cancer, tuberculosis and other spherical lesions in the lung can be distinguished from each other by the above characteristics. The “square sign” or “knife cut sign” refers to the fact that the lesion is close to the pleura, and the lesion is at right angles to the chest wall, indicating non-expansive growth of the lesion. Figure 3 2022-03-06 CT level 25, “spheroid lesions formed adjacent to the left upper lobe of the pleura,” “, the top left picture shows a typical “knife cut sign”, not the CT of this patient. Level 28, “air bronchus sign” formed by the passage of bronchioles within the spherical lesion. Combined with this case, through the above consolidation and study of spherical pneumonia, on the one hand, we avoid our clinical misdiagnosis and mistreatment, and increase the relevant clinical practice experience; on the other hand, it also reduces the need for patients Unnecessarily, the medical burden caused by premature and excessive positive inspections; secondly, it avoids too many possible results of the disease, communication with patients and their families, and the psychological burden brought about by them. References[1] Wang Xuecheng. CT manifestations of spherical pneumonia[J]. Chinese Journal of Medical Imaging, 2005,13(4):306-307.[2] Yang Feng, Zhang Hongquan. CT diagnosis of spherical pneumonia[J]. Journal of Practical Radiology, 2009,25(6):799-800,811.[3] Steiner P, Rao M. Spherical pneumonia. Chest. 1974 Aug;66(2):199-201.[4] Chinese Medical Association, Chinese Medical Association Clinical Pharmacy Branch, Chinese Medical Association Journal, etc. Adult Community Guidelines for rational drug use at primary level of acquired pneumonia[J]. Chinese Journal of General Practitioners, 2020,19(9):783-791.