纤维支气管镜对下肺野结核的诊断

当前,综合性医院是发现肺结核病人的主要单位之一。但是,对下肺野结核的误诊率较高,有报道达86％,因痰涂片找结核杆菌的阳性率低(40—60％),而采用纤支镜在肺内病变部位的刷检、活检做细菌学及病理学检查,能提高下肺野结核的确诊率。现将我院1991—1992年度经纤支镜检查后明确诊断的下肺野结核30例报告如下。     

肺结核误诊为肺癌的CT表现

本文对30例肺结核误诊为肺癌的CT表现作回顾性分析。CT表现分二类：1．段／叶型4例,病变支气管均见狭窄或阻塞。2．结节／肿块型26例,部位不典型占50％；病灶＞3cm占61．5％。有分叶(53．8％)、毛刺(57．7％)、空洞(30．8％)、胸膜凹陷(53．8％)。61．5％病例无卫星灶,5例伴肺门、纵隔淋巴结肿大。对误诊的原因和肺结核与肺癌的鉴别进行了讨论。     

肺结核合并癌性空洞27例CT分析

目的分析肺结核合并空洞型肺癌的病理与CT特点,评价肺结核灶、癌性空洞壁及其周围病灶的形态特点。方法回顾我院自2008年3月到2010年8月收治的肺结核存在空洞病例1102例中,经病理及临床证实的27例肺结核合并空洞型肺癌的病例,进行分析。结果根据CT表现,27例肺结核合并癌性空洞者,厚壁22例,薄壁5例,其中19例为偏心性,有浅液平6例,有壁结节23例,呈分叶状20例,毛刺征7例,伴卫星灶9例,胸膜尾征12例,血管集束征14例,胸腔积液10例。结论 CT检查对肺结核合并癌性空洞者有相当重要的临床诊断价值。     

Tuberculosis of the breast

The case histories of five women patients with mammary tuberculosis are described. All were treated by surgical excision of the lesion followed by antituberculosis chemotherapy. Recovery was uncomplicated in four of the patients but the fifth had a recurrence after 6 months for which a second operation was required. Tuberculosis of the breast is rarely diagnosed by clinical methods alone. The main problem is to distinguish it from pyogenic abscess in young women and from mammary carcinoma in older women. Surgical excision is often needed to prove the diagnosis. All patients should be given a standard course of chemotherapy but the value of surgery in the treatment of this disease has yet to be assessed.     

Tuberculosis of the esophagus

Summary Tuberculosis of the esophagus is rare. More cases of secondary tuberculosis of the esophagus have been reported compared to primary esophageal tuberculosis. An illustrative case of primary tuberculosis of the esophagus is presented and 54 published cases of esophageal involvement in tuberculosis are reviewed. There were eight primary and 46 secondary cases of esophageal tuberculosis. There were more male than female patients (M/F=2.6:1) with an average age of 39.2 years (range 6 months to 75 years). Diagnosis can be difficult, being based on clinical, radiological, endoscopic, and histological features and on the response to chemotherapy. Most cases can be successfully treated with antituberculous chemotherapy even in the presence of fistulous tracts. Patients with esophageal tuberculosis in the presence of AIDS do not respond as well to antituberculous chemotherapy.     

Tuberculosis of the breast

Tuberculosis of the breast is a rare malady. The clinician may confuse tuberculosis of the breast with either carcinoma or breast abscess. In the past 30 years at the First Teaching Hospital attached to Xi'an Medical University, only 23 patients reported herein had documented tuberculosis of the breast. Tuberculosis of the breast is a disease of younger women between 20 and 40 years of age. Mammary tuberculosis may be primary or secondary. There are three recognized modes of spread of the tubercle bacillus to the breast: hematogenous, lymphatic spread, and direct extension. There are three recognized types of mammary tuberculosis: nodular, diffuse, and sclerosing type. The diagnosis of mammary tuberculosis is difficult. The most reliable diagnostic studies include bacteriologic cultures of aspirate, histologic examination of tissue, and guinea pig inoculation. The differential diagnosis includes with carcinoma, acute or chronic mastitis with abscess. The treatment of tuberculous mastitis requires a combination of surgery and antituberculous drugs.     

Tuberculosis of the Esophagus

A case of tuberculosis of the esophagus is presented in a patient with pulmonary tuberculosis. The patient, complaining of dysphagia, had esophagoscopic examination which showed a submucosal tumor with central ulceration. Tissue biopsy, under direct vision from the tumor mass, confirmed the diagnosis of tuberculosis. The patient has been asymptomatic under treatment. Both esophageal and pulmonary lesions are largely improved.
The rarity of the lesion and necessity of taking biopsy are emphasized.     

Tuberculosis of the trachea

A patient is described who presented with stenosis of the upper trachea causing respiratory distress. There was no evidence of tuberculosis elsewhere in the body but biopsy showed a granulomatous lesion and there was a good response to anti-tuberculosis chemotherapy. A temporary tracheostomy was needed.