Pneumonic pseudotumor
Introduction
Introduction to pneumonia pseudotumor Pneumonia pseudotumor is a benign mass in the lung. It is a non-specific inflammatory proliferative tumor-like lesion of the lung parenchyma. It is a granuloma, mechanization, fibrous connective tissue hyperplasia and related secondary lesion formation caused by chronic inflammation in the lung. The lumps are not real tumors. Pneumonia pseudotumor is more common. Pneumonia pseudotumor accounts for the first or second place in benign lung tumors. basic knowledge The proportion of the disease: the probability of the population is 0.053% Susceptible people: more common in women under the age of 50 Mode of infection: non-infectious Complications: hemoptysis
Cause
Cause of pneumonia pseudotumor
Pulmonary infection (95%)
The disease is associated with bacterial and viral infections in the respiratory tract. It is a localized non-specific proliferative neoplastic lesion after pulmonary infection. The pathological changes are mainly fibroblasts, various inflammatory cells, tissue cells and vascular components. Irregular application of antibiotics localizes inflammatory lesions in the lungs, or delays absorption, resulting in increased morbidity.
Pathogenesis
The pathological features of pneumococcal pseudotumor are histological pleomorphism. The mass of granulation tissue in the mass varies from fibroblasts, plasma cells, lymphocytes, tissue cells, epithelial cells and inclusions. Foam cells or pseudo-xanoma cells of sexual fat and cholesterol, so many authors have different names and types according to the advantages of cell possession, such as pseudopapillary tumor type, fibroblastoma type, plasmacytoma type, false Lymphoma type, pathogen and pathogenesis are still unclear.
Pneumonia pseudotumor is generally located in the lung parenchyma, only a small number of bronchial involvement, the vast majority of single hair, round or oval nodules, generally no complete capsule, but the mass is more limited, the boundary is clear, and some Collagen fibrous connective tissue, which is thicker and lacks cells, is separated from the lung parenchyma. A small number of pneumococcal pseudotumions can develop cancer.
Prevention
Pneumonia pseudotumor prevention
The disease is related to bacteria and viral infections in the respiratory tract, and the irregular application of antibiotics limits the inflammatory lesions of the lungs, or delays absorption, so that the incidence increases, so proper exercise of the body has certain positive significance for preventing this disease. The other is to use antibiotics correctly.
Complication
Pneumonia pseudotumor complications Complications hemoptysis
The surgical treatment of this disease has a good prognosis, and there are few reports of complications. There have been reports of cases of massive hemoptysis death in elderly patients after lobectomy due to pneumococcal pseudotumor, but it is not common, so the patients are properly evaluated. Serious preparation for preoperative preparation is very important to reduce the complications of accidents, and it can also improve the success rate of surgery.
Symptom
Pneumonia pseudotumor symptoms Common symptoms Hemoptysis, chest pain, low fever
Most patients with pneumonia pseudotumor are under 50 years old, more women than men, and 1/3 of patients have no clinical symptoms. Only by accidental X-ray examination, 2/3 patients have chronic bronchitis, pneumonia, lung purulence The medical history, as well as the corresponding clinical symptoms, such as cough, cough, low fever, some patients have chest pain, blood stasis, and even hemoptysis, but the amount of hemoptysis is generally less.
Examine
Examination of pneumonia pseudotumor
1, X-ray inspection
Pneumonia pseudotumor can occur in any part of the lungs. The right upper lung (12/20) is more than the left upper lung (2/10), and the pseudotumor located in the lower lobe is mostly located in the inferior lobe and the inferior basal segment. The spherical tumor generally has a smooth and sharp edge, and the diameter is more than 1 to 4 cm. The density is relatively uniform, and the surrounding lung field is clear. The mass of the mass of the mass is unclear, the edge is blurred, and the density of some lesions is uneven. Concurrent acute inflammation can cause the "tumor" to enlarge, just like the flaky shadow of inflammatory infiltration around it. Therefore, whether the edge of the pseudotumor is clear or not depends on the pathological changes around the mass, and the boundary is clear. In the case of the capsule, if the lesion is in an acute stage, inflammatory exudation is observed around the pseudotumor, and there is a blurring around the tumor, and no pseudo-envelope is formed.
2, CT examination
The CT image shows the interface between the pseudotumor and the lungs very clearly. Even if the chest radiograph shows a large patch or a clump of blur, it shows a clear shadow on the CT image. The CT scan is flatter than the chest. It is easier to find the existence of small holes. This small cavity can be single or multiple. In addition, CT images show large burrs around the mass, thickening of the pleura, and adhesion signs are important for the diagnosis of this disease.
3, fiberoptic bronchoscopy, percutaneous lung puncture and intraoperative frozen pathological examination for the diagnosis and differential diagnosis of this disease is very important.
Diagnosis
Diagnosis and diagnosis of pneumonia pseudotumor
The diagnosis of pneumonia pseudotumor has certain difficulties. The clinical symptoms of patients are more difficult to distinguish from chronic bronchitis and lung malignant tumors. The chest X-ray is round or oval, with smooth and sharp nodules on the edges, and some edges are blurred. It seems to have burrs or lobes, which is difficult to distinguish from lung cancer. Pneumonia pseudotumors have no clear predilection sites in the lungs. The size can range from 1cm to 16cm, and most of them are below 4cm. These all cause difficulties in diagnosis and diagnosis. Should be based on pathological examination.
Differential diagnosis
Pneumonia pseudotumor is difficult to distinguish from lung cancer, tuberculoma, hamartoma, etc., which brings great difficulties to treatment.
1. Lung cancer
Clinically, the most important is the differentiation from lung cancer, which is directly related to the method of treatment and the scope of surgical resection. From the medical history, the age of patients with inflammatory pseudotumor is generally mild, and there is no history of long-term smoking. No obvious changes, there may be a history of fever, no persistent blood in the sputum, no extrapulmonary symptoms; from the imaging point of view, inflammatory pseudotumor is generally located in the periphery of the lung, isolated lump shadow, but also multiple lesions The size varies, the density of the tumor is more uniform, there may be calcification, hollow, but this is rare; in most cases, there are spots around the mass; mediastinal lymph nodes are not sure that the tumor is cancer, and the lung cancer is mostly lobulated. Shape, edge roughness is not smooth, density is uneven, necrotic area density is lower, which may be related to the growth of tumor tissue activity, may be associated with pleural effusion, lung and mediastinal lymph node metastasis, lung tumor radionuclide imaging The examination is helpful for determining the nature of the mass. Negative can generally exclude the tumor, but the positive patient should be cautious in determining the tumor. About 10% of the patients may have false positives. , May generally determine the nature of the tumor.
The identification points with lung cancer are:
(1) The clinical symptoms of pseudotumor are mild or asymptomatic, and the symptoms of lung cancer are obvious and gradually worsened.
(2) The tumor growth of the pseudotumor is slow or no growth, while the lung tumor has a short doubling time and rapid development.
(3) CT scan can be seen in single or multiple small holes in a pseudotumor, even in a hive-like translucent. The cavity of lung cancer is generally eccentric thick-walled cavity, with cancerous nodules in the cavity, rarely in a cancerous foci. The hive looks like a low density shadow.
(4) The pseudotumor was examined in the sputum, and no cancer cells were detected in the bronchoscopy biopsy.
2, tuberculosis
The distinguishing point from the tuberculosis ball is that the tuberculosis ball is easy to occur in the posterior segment of the upper tip of the lung or in the dorsal segment of the lower lobe. The density is uniform and there may be calcification. There may be a satellite foci around the lesion. The lung cancer is prone to occur in the anterior segment of the upper lobe. Signs such as lobes, umbilical concavities, and short burrs are helpful for identification with pseudotumors.
The disease also needs to be differentiated from chronic bronchitis and lung malignant tumors, benign lung tumors and pleural mesothelioma.
