目的 探讨小于4 cm的胃神经鞘瘤（GS）的CT误诊与漏诊原因,从而加深影像科医师对GS的认识,提高其CT检出率及诊断准确率。方法 回顾性分析2019年3月—2022年10月经手术切除及病理证实的10例小于4 cm的GS患者的临床、CT及病理资料。在CT图像上评估肿瘤的位置、大小、形态、密度、强化特点及周围淋巴结等情况。结果 术前CT误诊7例,漏诊2例,仅1例正确诊断;10例病灶均起源于胃黏膜下;9例为圆形或类圆形;7例发生于胃体;平扫密度均低于肌肉组织,均呈渐进性强化。结论 小于4 cm的GS术前误诊率很高,且可发生漏诊。当CT检查提示胃体部黏膜下圆形或类圆形占位病变,平扫呈均匀稍低密度,增强呈渐进性强化时应考虑GS的可能,最终确诊需病理及免疫组化检查。

Objective To investigate the causes of CT misdiagnosis and missed diagnosis of gastric schwannomas（GS）smaller than 4 cm in size,and to improve radiologists’ awareness of GS and increase the detection rate and diagnostic accuracy．Methods Clinical,pathological and CT data of ten surgically and pathologically confirmed GS patients were retrospectively reviewed between March 2019 and October 2022．The location,size,shape,attenuation,enhancement features and surrounding lymph nodes of each tumor on CT were analyzed．Results Of the 10 patients,7 cases were misdiagnosed in preoperative CT examination,two cases were missed diagnosed and only one case was correctly diagnosed．All tumors originated from the submucosa in ten cases,and nine cases showed a round or oval shape．Seven lesions were located in the gastric body,and all tumors had homogeneous low attenuation compared to muscle on plain CT images．All cases displayed mild-moderate to obvious enhancement．Conclusions GS smaller than 4 cm have a high rate of misdiagnosis and missed diagnosis preoperatively．When CT examination indicates a submucosa tumor with a round-like shape in the gastric body and homogeneous mild hypoattenuation on plain CT,the possibility of GS should be raised．Pathological and immunohistochemical examinations are necessary to confirm the final diagnosis．

目的 回顾性分析支气管肺泡细胞癌(bronchioloalveolar carcinoma,BAC)临床特点,提高早期BAC的确诊率,减少误诊。方法 对2013年—2014年间在我院确诊的BAC病例5例的临床资料进行回顾性分析。结果 5例患者中男4例,女1例,年龄在50～73岁之间,在社区医院均曾误诊为肺炎,所有患者均在我院经支气管镜肺活检后确诊为BAC。结论 BAC是一种较为特殊的肺癌,临床上症状无特异性,极易误诊为普通肺炎。由于BAC预后差,误诊后果严重,对初诊为普通肺炎的患者经常规抗感染治疗后临床症状及影像学表现改善不明显时,应及时进行各项检查、明确诊断,以便有效改善患者预后。

Objective To elevate the clinical diagnosis of BAC (bronchioloalveolar carcinoma) so as to reduce misdiagnosis by using retrospective analyses. Methods Retrospective analyses were used to study the five BAC patients, who were diagnosed in our hospital from 2013 to 2014. Results 4 of 5 male, and 1 female, age between 50 and 73, were diagnosed as pneumonia. All of them were made a definite diagnosis as BAC after performing transbronchial lung biopsy. Conclusion BAC is an exceptional lung adenocarcinoma and there is no specific clinic symptom. BAC was easily misdiagnosed as common lung pneumonia. There will be serious consequences after misdiagnosis of BAC due to its poor prognosis. Those patients who were misdiagnosed as common lung disease, but there was no obvious improvement after accepting long anti-infective therapy and there was negatively detection of pathogenic bacteria in them, are needed to perform all other clinical examination to clarify a diagnosis, and to further improve the prognosis of the patients.