CHEN Lulu , ZHANG Yingwei , ZHAO Qi , LIU Yin , LI Hui , DING Jingjing , CAI Hourong , XIAO Yonglong
  • Department of respiratory medicine, The Affiliated Drum Tower Hospital of Nanjing University, Nanjing, Jiangsu 210008, P. R. China;
ZHANG Yingwei, Email: yingwei16@aliyun.com
Tuberculosis; misdiagnosis; alveolar proteinosis; crazy-paving pattern
10.7507/1671-6205.201902028
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Objective Three cases of pulmonary tuberculosis misdiagnosed as pulmonary alveolar proteinosis were reported and analyzed in combination with literatures, so as to improve the ability of differential diagnosis of these two diseases. Methods The clinical data of 3 cases of pulmonary tuberculosis patients which were diagnosed by pathology whose imaging manifestations were similar to those of pulmonary alveolar proteinosis were collected and reviewed in combination with relevant literature. Results All the 3 patients were male, with a chronic course , no typical clinical manifestations of pulmonary tuberculosis, CT imaging showed diffuse glass grinding shadow, thickened pulmonary lobular septa ,showed "Crazy-paving pattern". ALL the three patients were considered as " pulmonary alveolar proteinosis" initially, and finally confirmed by lung biopsy or acid-resistant bacilli found by bronchoalveolar lavage. Reviewing 8 literature reports with similar imaging findings, 1 case was misdiagnosed as pulmonary alveolar proteinosis, 3 cases were pulmonary alveolar proteinosis combined with pulmonary tuberculosis, and 4 cases were secondary pulmonary alveolar proteinosis. It was found that most patients had systemic or respiratory symptoms of pulmonary tuberculosis. CT images mainly showed diffuse ground glass shadows in bilateral lungs with thickening of lobular septa, and 3 patients also showed clustered small nodulars. Most patients improved after anti-tuberculosis treatment, with only one patient dying. Conclusions The imaging manifestations of atypical pulmonary tuberculosis are various, which are easy to be misdiagnosed when they are similar to " pulmonary alveolar proteinosis". Clinicians should raise their awareness of tuberculosis with this imaging characteristic.

Citation： CHEN Lulu, ZHANG Yingwei, ZHAO Qi, LIU Yin, LI Hui, DING Jingjing, CAI Hourong, XIAO Yonglong. Three cases of pulmonary tuberculosis misdiagnosed as pulmonary alveolar proteinosis. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(8): 578-582. doi: 10.7507/1671-6205.201902028 Copy

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