| ObjectiveThrough a retrospective analysis clinical data of 63 cases of ederly atypical pulmonary tuberculosis,we analyze clinical and imaging features to improve the alertness and diagnosis rate of atypical tuberculosis in the elderly.MethodsA retrospective analysis in January 2017 to October 2018,63 cases of ederly atypical pulmonary tuberculosis with clinical data and chest CT imaging findings in the hospital from Tianjin Medical University General Hospital.Statistical analysis was performed using SPSS 23.0 software.ResultsOf the 63 elderly atypical pulmonary tuberculosis,39 were male and 24 were female.There were more males than females.The ratio of male to female was 1.625:1,of which 70 to 79 were the most common,with 29 cases in total.A total of 34 patients had a history of smoking,accounting for 54%,of which 72% were male smokers,25% higher than females.The clinical manifestations were cough(80.1%),followed by chest tightness,difficulty breathing(41.3%),row(36.5%),fatigue(27.1%),fever(25.6%),low fever(22.2%),and weight loss(25.4%),while chest pain(9.5%),night sweats(9.5%),hemoptysis(7.9%)performed less.There was no significant difference in symptoms between men and women(P>0.05).A total of 43 patients underwent sputum smear acid-fast bacilli examination,9 cases of smear-positive(20.9%),more patients with smear-negative pulmonary tuberculosis than smear-positive.33 patients underwent fiberoptic bronchoscopy,9 cases(9/27,33.3%)of the acid-fast bacilli were found,of which 5 cases(5/23,27.1%)were positive for brush biopsy,6 cases(6/27,22.2%)were positive for bronchoalveolar lavage fluid.Compared with them,the positive rate of bronchoalveolar lavage fluid was the highest,and the positive rate of sputum smear was the lowest(P<0.05).Among 34 patients with sputum smear negative,the positive rate of acid-fast bacilli in fiberoptic bronchoscopy was 32.0%(8/25),the positive rate of Xpert MTB/RIF in bronchoalveolar lavage fluid was 95%(19/20),and the positive rate of Xpert MTB/RIF in sputum was 83.3%(5/6),T-SPOT.TB positive rate is 71.4%(15/21).The distribution of lesions was more common in both lungs,and the lesions were distributed in multiple lung areas(36/63,57.1%).The lesion in the single lung area was predominantly in the upper right lung(10/63,15.9%),followed by 9.5% in the left upper lung.The right lower lung was 7.9%,the left lower lung was 4.8%,and the right middle lung was 3.2%.The imaging findings were mainly segmental or lobular consolidation(36.5%),followed by isolated nodules or masses(33.3%),multiple nodules(12.7%),cavities(12.7%),and interstitial lesions.(3.2%)with large lymph nodes(1.6%).This group of 63 patients were associated with underlying diseases,24 patients(38.1%)with more than two diseases,including pneumonia,(29/63,46.0%),followed by hypertension(42.9%),diabetes(38.1%),coronary heart disease(31.7%),old cerebral infarction(17.5%),chronic lung disease including chronic bronchitis,pulmonary heart disease,bronchiectasis,lung Interstitial lesions(15.9%),rheumatoid arthritis(3.2%),ankylosing spondylitis(1.6%).According to the diagnosis of fiberoptic bronchoscopy accounted for 27.0%,bronchoscopy acid-positive staining,bronchoscopy biopsy accounted for 14.3% 、 12.7%;pathological and sputum smear-positive patients accounted for 25.4%、14.3% ConclusionThe clinical manifestations and imaging findings of elderly atypical pulmonary tuberculosis are often atypical.There are many patients with smear-negative pulmonary tuberculosis.It should be combined with clinical symptom,laboratory examination,imaging and other comprehensive methods to improve the diagnosis rate of senile pulmonary tuberculosis patients and reduce missed diagnosis... |
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