以肺实变为主要表现的淋巴瘤1例

正患者男,46岁,因"间断咳嗽、咳痰、发热2年,加重伴呼吸困难半月"于2015年1月30日入院。患者2年前因受凉后开始出现咳嗽、咳痰,伴发热,T38℃以上,伴活动后气促,在当地医院行胸部CT提示:肺部感染,经抗感染治疗后症状好转,未复查胸部CT。2年间患者数次出现类似症状,自行在诊所输液治疗后症状可缓解,但渐进出现活动后气短、乏力、精神差。半月前上述症状再发加重,咳少量黄色     

1例以肺实变为主要表现的淋巴瘤

目的：探讨肺淋巴瘤的临床特征，提高对本病的认识。方法：对一例以双肺实变为主要表现的肺继发性淋巴瘤的临床资料进行整理和分析，并复习相关文献。结果：此例中年男性患者反复出现咳嗽、咳痰、发热，经抗感染治疗后症状可缓解，但出现进行性加重的活动后气短，胸部CT提示以右肺为主的双肺实变，经病理诊断为肺淋巴瘤。结论：肺淋巴瘤临床表现无特异性，影像学特征多变，肺活检是确诊肺淋巴瘤的金标准；如遇难以治愈的肺实变病例，应想到淋巴瘤可能。     

误吸石蜡油致外源性类脂性肺炎一例

<正>外源性类脂性肺炎(exogenous lipoid pneumonia, ELP)是指油脂类物经呼吸道误吸入肺内所致的肺部急慢性炎症^[1]。该病为少见病,临床及影像学表现缺乏特异性,容易延误诊治。现将太原市第四人民医院收治的1例经穿刺活检病理证实的ELP诊疗经过报道如下。临床资料患者,女,67岁,主诉“间断腹痛1月余,咳嗽咳痰伴喘息半月”入院。患者于1个月前无明显诱因出现右上腹疼痛,进食后加重,伴恶心、呕吐,发热,     

肺多发性不典型类癌1例报道并文献复习

临床资料患者女,51岁,家属,因咳嗽、左上胸部疼痛1周于2009年6月26日入院。患者1周前无明显诱因出现阵发性、刺激性干咳,伴左上胸部锐痛,夜间明显,左侧卧位后有所缓解。无发热、咯血、盗汗,行走或料理家务时伴有气短。于2009年6月24日在我院门诊行胸部CR及CT检查示：左肺占位性病变并上叶阻塞性肺不张入院。否认肝炎、肺结核病史,     

原发性肺透明细胞癌1例并文献复习

原发性肺透明细胞癌在组织病理学分类中是大细胞肺癌的亚型,占原发性肺癌发病率的比重较低,资料报道约为0．8％-3、4％。搜索国外文献,近十几年原发性肺透明细胞癌的临床资料报道较少,为探讨肺透明细胞类癌的临床病理特征、诊断与鉴别诊断要点、治疗及预后。现对本院呼吸科的1例肺原发性透明细胞癌老年男性患者进行临床病理分析。     

肝移植术后卡氏肺孢子菌肺炎1例报告

<正>1病例资料患者男性,60岁,因"肝移植术后3个月余,咳嗽、少痰1周"入院。曾于2017年10月1日因诊断"乙型肝炎肝硬化失代偿期合并腹水、原发性肝癌"在本院行"同种异体原位全肝移植术",术后常规抗排斥、预防乙型肝炎复发等治疗,本院门诊规律随访。2018年1月5日,患者自觉食欲欠佳,食量减少1/3,晨起咯少量白痰。1月9日,复查血常规:WBC 2. 03×10~9/L、中性粒细胞百分比43. 00%、RBC 2. 99×10~(12)/L、Hb 86. 00 g/L、PLT     

The effect of pulmonary fibrosis on survival in patients with hypersensitivity pneumonitis

PURPOSE: To determine the effect of pulmonary fibrosis on survival in an unselected group of patients with hypersensitivity pneumonitis. METHODS: We identified 72 patients with hypersensitivity pneumonitis confirmed by surgical lung biopsy in the database of the Clinical Interstitial Lung Disease Program at the National Jewish Medical and Research Center. All biopsy specimens were scored according to the presence or absence of fibrosis. Comparisons were made between patients with (fibrotic group) and without (nonfibrotic group) pathologic fibrosis. Vital status was ascertained and Kaplan-Meier curves were plotted. Cox regression analysis was used to determine predictors of survival. RESULTS: Forty-six patients were classified as fibrotic and 26 as nonfibrotic. Twenty-nine percent had exposure to a bird antigen, 33% had exposure to a microbial antigen, and 38% had unknown exposure. Patients with fibrosis were significantly older, showed greater restrictive lung physiology, and had greater all-cause and respiratory mortality. Median survival in fibrotic patients was 7.1 years, which was significantly less than survival in those without fibrosis. In an age-adjusted regression analysis, antigen class, symptom duration, and lung function had no effect on survival. Only the presence of pathologic fibrosis was predictive of increased mortality (hazard ratio = 6.01; 95% confidence interval: 1.68 to 21.45; P = 0.006). CONCLUSION: Pulmonary fibrosis is associated with diminished survival in patients with hypersensitivity pneumonitis.     

Chronic hypersensitivity pneumonitis caused by Aspergillus complicated with pulmonary aspergilloma

A 57-year-old man consulted our hospital with a history of the gradual onset of dyspnea and a productive cough. Chest computed tomographic (CT) scans showed a nodular shadow in a cavity lesion, and reticulonodular, cystic, and ground-grass opacities in the bilateral lung fields with honeycombing. He was diagnosed as having pulmonary aspergilloma and idiopathic pulmonary fibrosis (IPF). As an outpatient, he suffered from dyspnea upon physical exertion with exacerbation of the high-resolution CT (HRCT) opacities. An inhalation provocation test for Aspergillosis fumigatus was positive and chronic hypersensitivity pneumonitis (CHP) caused by Aspergillus was finally diagnosed. Insidious CHP is sometimes misdiagnosed as IPF. The diagnosis of insidious CHP should be made on the basis of a detailed history, specific HRCT findings, and lymphocyte-dominant bronchoalveolar lavage fluid cell findings.     

Summer-type hypersensitivity pneumonitis with remarkable obstructive impairment of pulmonary function]

A 57-year-old-man was admitted because of persistent cough and progressive dyspnea over a period of 2 months. Examination revealed wheezing in both lungs, severe hypoxemia, and marked obstructive impairment of pulmonary function. A chest CT scan showed diffuse small nodular lesions with patchy air space opacifications. The patient was initially given a diagnosis of bronchiolitis of unknown cause. He showed marked improvement after treatment with oral prednisolone, but developed fever and dyspnea after returning home. This episode indicated hypersensitivity pneumonitis, a diagnosis supported by findings of increased CD 8 positive T-lymphocytes in bronchoalveolar lavage fluid, and a high titer of serum anti-Trichosporon antibody. Lung biopsy samples obtained under video-assisted thoracoscopy disclosed noncaseating granulomas in terminal and respiratory bronchioles, which resulted in marked narrowing of the lumen. The pathologic changes seemed to be consistent with obstructive impairment of pulmonary function in this patient.     

Decreased pulmonary perfusion in hypersensitivity pneumonitis caused by Shiitake mushroom spores

Hypersensitivity pneumonitis is an occupational hazard of mushroom workers. We describe a patient with severe hypersensitivity pneumonitis caused by spores of the Shiitake mushroom ( Lentinus edodes ) who showed a marked decrease in pulmonary perfusion, as demonstrated by pulmonary scintigraphy. This patient was treated successfully with prednisolone. These results suggest that pulmonary vasculitis may be associated with patients with hypersensitivity pneumonitis, and that steroid therapy may be clinically useful in treatment.     

CT findings of hypersensitivity pneumonitis

CT findings of 22 cases of hypersensitivity pneumonitis (HP) were evaluated on 1 cm slices. All cases were diagnosed by transbronchial lung biopsy and clinical information. The study population included 8 men and 14 women with a mean age of 43 years. The causative antigens were considered to be so-called summer type in 17 cases, air humidifier in 1, pigeon in 1 and paint spray (isocyanate was suspected) in 3. CT examination were performed at a mean of 1.5 weeks after admission. In conclusion, characteristic CT findings of HP include combination of small nodular shadows and slight elevation of lung density. The size of nodular shadows was usually within 1 cm diameter, and their distribution was considered to be a centrilobular pattern, representing alveolitis and granuloma formation in a secondary lobule. It was though that the slight elevation of lung density developed when the disease extended all over the secondary lobule and the nodules developed when the disease was limited to the centrilobular lesion. In most cases, significant changes in proximal bronchi and pulmonary vasculatures could not be detected. The presence of segmental or lobar distribution of the shadows was also suggested. In addition to the typical findings, various other findings were also revealed; irregular shaped dense shadows, subpleural curvilinear shadow and honeycombing formation, especially in chronic cases. These findings have caused some difficulty in distinguishing HP from other interstitial diseases. More precise information can probably be obtained by thin slice CT than by 1 cm slice thicknesses, nevertheless, the standard method of CT should yield a useful diagnostic imaging.