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1 病例资料 患者男性,76岁,进行性加重的喘憋,吞咽困难3月余,于1998年1月来院就诊。查体:T37℃,P86次/分,R20次/分,BP17/12KPa。神志清晰,营养一般,五官、心、肺及腹部无异常。右侧甲状腺肿大明显,活动,质韧。颈部及锁骨上下区淋巴结未触及。血、尿、大便常规检查正常;肝功能、心电图、胸部X线正常。甲状腺CT扫描:右侧甲状腺肿大,约10×7.5×12cm,气管及食管受压并向左侧移位。诊断:甲状腺瘤。于1998年2月实施甲状腺瘤摘除术,手术顺利。病理报告:甲状腺腺瘤。术后呼吸正常,但仍吞咽困难。食道钡餐检查中下段肿物约9cm,管腔狭窄,病理报告:鳞状上皮细胞癌。2 误诊分析及建议2.1 复习文献,甲状腺瘤多发于40岁以下女性患者。本例虽
1 Case information The patient was male, 76 years old, with progressive aggravated asthma, dysphagia more than 3 months, and came to the hospital in January 1998. Physical examination: T37°C, P86 beats/min, R20 beats/min, BP17/12KPa. Consciousness, nutrition, no abnormalities in the features, heart, lungs, and abdomen. Right side of the goiter is obvious, active, tough quality. Neck and upper and lower clavicle lymph nodes were not touched. Routine blood, urine, and stool examinations were normal; liver function, electrocardiogram, and chest X-ray were normal. Thyroid CT scan: right side of the goiter, about 10 × 7.5 × 12cm, tracheal and esophageal pressure and shift to the left. Diagnosis: thyroid tumors. The removal of thyroid tumors was performed in February 1998 and the operation was successful. Pathology report: thyroid adenoma. After the operation, her breathing was normal, but swallowing was still difficult. In the esophageal barium meal examination, the lower part of the tumor mass was about 9 cm, and the lumen was narrow. Pathology report: Squamous cell carcinoma. 2 Misdiagnosis Analysis and Suggestions 2.1 Review the literature, thyroid tumors occur in women under the age of 40. Although this example