Analysis of the clinical characteristics and misdiagnosis causes of central lung cancer

LIU Yang

doi:10.3969/j.issn.1002-3429.2026.05.004

Abstract：Objective To analyze the clinical characteristics and causes of misdiagnosis in patients with central lung cancer(CLC),and to summarize countermeasures to prevent such misdiagnosis.Methods A retrospective analysis was conducted on the clinical data of 9 patients with central lung cancer who were initially misdiagnosed from January 2022 to December 2023.Results Two patients presented with symptoms of cough,fever,white frothy sputum,and dyspnea.X-ray showed pulmonary parenchymal lesions and blurred hilar regions,and CT showed round high-density opacities in the perihilar region accompanied by emphysema or atelectasis,based on which they were misdiagnosed with infiltrative pulmonary tuberculosis.Four patients presented with respiratory symptoms such as cough.X-ray showed blurred hilar regions and disordered textures,and CT showed round mass shadows in the perihilar region.They were misdiagnosed with pulmonary tuberculosis.Two patients presented with chest tightness,shortness of breath,and swelling in the neck.X-ray showed widened mediastinum,and CT showed mediastinal round masses accompanied by atelectasis,based on which they were misdiagnosed with mediastinal tumors.One patient presented with long-term fever,purulent sputum cough,and chest pain.CT showed solid lesions in the lungs with cavity formation,blurred edges or spicules,and the patient was misdiagnosed with lung abscess.Six patients were diagnosed by bronchoscopic biopsy,and three patients were diagnosed by positive cancer cells in sputum combined with imaging findings.All were diagnosed as CLC,with misdiagnosis periods ranging from 1 to 5 months.Three patients received conservative treatment(with one patient remaining stable)or chose to discontinue treatment due to poor cardiac and pulmonary function or extensive metastasis(two patients died).Three patients experienced tumor stabilization or shrinkage after chemotherapy,one patient had no recurrence after radiotherapy and chemotherapy,and two patients died within 5 d after diagnosis due to septic shock and massive hemoptysis asphyxia respectively.Conclusion The early symptoms of CLC are not typical,and it is prone to misdiagnosis.Understanding its clinical and imaging characteristics,maintaining a high index of suspicion for high-risk individuals,and promptly using diagnostic tools such as bronchoscopy biopsy and sputum cytological examination,along with careful differential diagnosis,can help reduce misdiagnosis.