骨化性气管支气管病1例

患者男性,35岁.反复咳嗽、咳痰3个月,对症治疗效果不佳.查体:体温36.1 ℃;咽部充血,右肺呼吸音粗,可闻及细小水泡音;左肺呼吸音清.胸部CT示右肺中叶斑片状模糊影,考虑炎症.纤维支气管镜活检病理诊断:支气管黏膜慢性炎症.经正规抗感染治疗后,复查胸部CT,炎症明显吸收.纤维支气管镜下见气管中下段及左总支气管管壁内布满大小不一的黄色附着物.     

骨化性气管支气管病1例诊治报道

骨化性气管支气管病比较少见,病因病机至今仍未探明,临床表现缺乏特异性,容易误诊、漏诊.随着胸部CT和电子支气管镜应用的不断推广,近年来临床病例的确诊和报道陆续增多,进一步提高了临床医师对该病的认识.回顾相关文献发现,报道以Ⅰ期散发型、Ⅱ期弥漫型骨化性气管支气管病患者相对多见,Ⅲ期融合型骨化性气管支气管病鲜有报道.现就我...     

骨化性气管支气管病2例报告并文献复习

目的提高对骨化性气管支气管病(TO)的认识。方法报告2例TO患者的临床资料,结合国内外文献进行分析。结果 TO好发于成年人,男性发病率略高,无特异性临床症状。支气管镜下可见气管及主支气管前壁和侧壁多发质硬的结节突向管腔,后壁通常不受累。根据胸部CT及支气管镜下特征性改变可诊断TO。组织病理活检可见气道黏膜下骨性或软骨性结节形成,结节常可继发钙化。目前尚无针对TO的特异性治疗方法,少数导致气道重度狭窄的患者可行支气管镜介入治疗或外科手术治疗。结论 TO是一种良性疾病,预后较好,胸部CT、支气管镜有特征性改变,可以确诊。     

骨化性气管支气管病1例

骨化性气管支气管病(tracheobronchopathia osteochon- droplastica,TO)亦称骨形成性气管病,是指气管、支气管黏膜下有多发性骨质或软骨组织结节样增生,并向管腔生长,引起管壁变硬,管腔狭窄甚至阻塞的良性气道病变。现报道1例TO并作文献复习。     

骨化性气管支气管病误诊为支气管内膜结核

1　病例资料女 ,31岁。因反复咳嗽、咳痰、活动后气短 ,间断痰中带血 10年 ,加重半月入院。患者于 1991年春感冒后出现咳嗽 ,咳少量白粘痰 ,痰中带血 ,在外院按急性支气管炎治疗症状好转。此后每遇受凉或感冒反复出现上述症状且逐渐加重 ,多次行Ｘ线胸片、胸部ＣＴ检查未提示异常。先后 3次纤维支气管镜 (ＦＢ)检查均提示 :粟粒状结节灶附着于气管及左右主支气管壁上 ,腔内大量脓性分泌物 ,抗酸染色阴性。红细胞沉降率 2 9ｍｍ/ｈ ,结核菌素纯蛋白衍生物 (ＰＰＤ)试验 2次均 (2 + )。曾在外院诊断为气管支气管内膜结核 ,行正规抗结核治疗1 5…     

骨化性气管支气管病1例

患者男．31岁，因反复咳嗽咳痰半年，伴胸闷气促半月于2006年5月20日人院。患者半年前因咳嗽、咳痰于我院就诊，受凉后明显，予以抗感染及对症处理后，咳嗽好转。此后未复查。半个月前患者无明显诱因下出现胸闷气促．活动后加重，并伴有咳嗽、咳痰，为黄色黏痰，带有血丝。[第一段]     

骨化性气管支气管病误诊1例

患者女,41岁,因"咳嗽,咳痰3年,胸闷1年"于2011年5月9日入院。自诉3年前无明显诱因出现咳嗽,咳黄绿色脓痰,无发热、咯血,给予间断抗感染治疗,咳痰可明显减少,但咳嗽无改善。近1年感体力活动时胸闷     

骨化性气管支气管病1例报道并文献复习

患者,女,41岁,农民,间断咳嗽、咳白痰半年,痰中带血丝1周,于2010年6月来河北医科大学第四医院就诊。患者于2010年1月出现咳嗽,咳少量白色黏痰,无发热盗汗,无痰中带血,无咯血,无活动后气促,不伴有胸痛,未予诊治。2010年6月出现痰中带少量鲜红色血丝,当地县医院胸部CT检查示气管壁有多发性的点状或斑点状钙化影并突入管腔、     

骨化性气管支气管病误诊为支气管内膜结核1例

病例女,42岁,2007年因咳嗽来我院就诊。行纤维支气管镜（纤支镜）检查,见气管及隆突前壁大量结节,呈铺路石样改变。经抗感染治疗,后复查气管镜未见明显改变。再行CT检查,CT表现（图1,2）：气管中下段及主支气管壁增厚,前、侧壁发现散发或多发斑块状结节,突向管腔,     

纤维支气管镜引导下微波组织凝固治疗骨化性气管支气管病1例

1 临床资料患者男性,24岁,教师。以反复咳漱、咳痰1.5年于2003年5月8日来我院就诊。1年半前患者因受凉后开始反复咳漱、咳痰,痰有白黏痰和黄脓痰,痰中带血,多次在外院拍胸片示“正常”,间断抗感染治疗(具体不详),症状时轻时重。病程中无胸痛、气促,无发热、盗汗。既往身体健康。体检:体温36.2℃,脉搏70次/min,呼吸18次/min,血压100/70 mmHg,双肺呼吸音粗糙,无罗音,心、腹无异常。胸部螺旋CT示气管壁可见点状钙化影突入管腔。纤维支气管镜(纤支镜)检查示气管中下段、左右主支气管、右上叶、中叶支气管可见多发大小不等钟乳石样结节突入管…     

A case of tracheobronchopathia osteochondroplastica diagnosed by fiberoptic bronchoscopy upon removal of an aspirated crown

Tracheobronchopathia osteochondroplastica (TO) is a relatively rare benign disease, around 300 and 130 cases have been reported in English and Japanese literature, respectively. Most of the cases have been diagnosed incidentally at autopsy. Due to the widespread use of fiberoptic bronchoscopy (FOB), the number of cases diagnosed upon examination is increasing. Here, we report a case of a 72 year-old man with a history of crown aspiration, who was diagnosed as TO upon removal of a foreign body using FOB. The diagnosis of TO and the removal of an aspirated crown by FOB are discussed.     

超声诊断肝结核伴脾结核一例

1 临床资料 患者,女,43岁,因乏力、腹痛、持续发热20 d就诊.化验检查:结核菌素试验(+),胸部透视未见明显异常,血常规正常.超声所见:肝右叶近膈面可见3.5 cm×4.7cm低回声区,边界欠清,其内回声不均匀,周边无声晕.脾脏大小形态正常,厚约4.5 cm,长径约11.5 cm,脾实质内可见散在的低回声结节,最大者约1.9 cm×2.3 cm,边界清,内部为均匀低回声.     

Active pulmonary tuberculosis with vertebra and rib involvement: case report

Multifocal skeletal tuberculosis is defined as osteoarticular lesions that occur simultaneously at two or more locations and is generally associated with disseminated disease. Although involvement of bones accounts for 1 to 5% of all tuberculosis cases, multifocal involvement of the skeleton is extremely rare. We present a case of active pulmonary tuberculosis (TB) with vertebral and rib involvement and multiple hypodense lytic lesions accompanied by a paravertebral mass lesion. In the differential diagnosis, metastases, lymphoma, multiple myeloma, chordoma sarcoidosis and rare spinal infections such as brucellosis and fungal disease were considered. The diagnosis was established by surgical biopsy, taken by video-assisted thoracoscopic surgery. Especially for patients from TB-endemic areas, tuberculosis must be considered in the differential diagnosis and treatment should be started without delay.     

Esophageal tuberculosis complicated with intestinal tuberculosis: A case report

BACKGROUND Although the overall incidence of tuberculosis in underdeveloped areas has increased in recent years, esophageal tuberculosis(ET) is still rare. Intestinal tuberculosis(ITB) is relatively more common, but there are few reports of ET complicated with ITB. We report a case of secondary ET complicated with ITB in a previously healthy patient.CASE SUMMARY A 27-year-old female was hospitalized for progressive dysphagia, retrosternal pain, acid regurgitation, belching, heartburn, and nausea. Upper gastrointestinal endoscopy showed a mid-esophageal ulcerative hyperplastic lesion. Endoscopic ultrasonography showed a homogeneous hypoechoic lesion, with adjacent enlarged lymph nodes. Biopsy histopathology showed inflammatory exudation,exfoliated epithelial cells and interstitial granulation tissue proliferation.Colonoscopy revealed a rat-bite ulcer in the terminal ileum and a superficial ulcer in the ascending colon, near the ileocecal region. The ileum lesion biopsy showed focal granulomas with caseous necrosis. Polymerase chain reaction for Mycobacterium tuberculosis was positive in the esophageal and ileum lesion biopsies. The T-cell spot tuberculosis test was also positive. The patient was diagnosed with secondary ET infiltrated by mediastinal lymphadenopathy and complicated with ITB, possibly from the Mycobacterium tuberculosis-infected esophageal lesion. After 2 mo of anti-tuberculosis therapy, her symptoms improved significantly, and upper gastrointestinal endoscopy showed healing ulcers.CONCLUSION When dysphagia or odynophagia occurs in patients at high-risk for tuberculosis,ET should be considered.     

支原体肺炎合并肺血栓栓塞症1例临床分析

目的 探讨儿童肺炎支原体肺炎（MPP）合并肺血栓栓塞症（PTE）的临床特点和诊断、治疗要点及相关危险因素。方法 回顾性分析1例MPP合并PTE的病历资料,复习文献,探讨MPP合并PTE的诊断要点、治疗方法及血栓相关危险因素。结果 患儿为7岁女童,学龄期,以呼吸道症状起病,发热、咳嗽为主要表现,有一过性胸痛、呼吸困难及低氧血症表现,病程14天出现PTE。左下肺叩诊浊音,左侧胸部呼吸音减低,可闻及少许湿啰音。辅助检查：胸腔积液淡黄、清亮。肺炎支原体抗体IgM 1∶320,血浆D 二聚体11.8 mg/L,肺动脉造影(CTA)示左上肺动脉及右下肺动脉部分分支内充盈缺损,心脏超声检查示左肺动脉起始部血栓形成,抗核抗体（ANA）（+）,狼疮抗凝物阳性,血浆蛋白S活性降低（59.5%）,出凝血疾病基因突变未检出。诊断PTE、MPP、胸腔积液,拉氧头孢钠联合阿奇霉素抗感染,地塞米松抑制炎症反应,肝素钙、利伐沙班抗凝治疗后,患儿症状、体征好转,胸腔积液消失,D 二聚体逐渐下降至0.1 mg/L。结论 MPP患儿有胸痛、呼吸困难,尤其伴有D 二聚体明显升高时,要考虑合并PTE可能,CTA可明确诊断,对于存在多个危险因素或有肺栓塞高度风险的患儿应及早行CTA检查,血栓形成可能与支原体感染导致的过度炎症反应及血管内皮损伤有关。     

以间质性改变为主要表现的肺结核一例并文献复习

目的提高对以肺间质性改变为主要表现的肺结核的认识。方法报道1例2011年确诊的以肺间质改变为主要表现的肺结核患者的临床资料、诊治经过及随访情况,并进行相关文献复习。以"间质,肺结核"为检索词通过万方医学数据库对中文文献检索,以"interstitial,pulmonary tuberculosis"为检索词通过Pub Med数据库进行检索,检索时间截至2014年5月。结果患者女,31岁,因"咳嗽6个月,加剧伴气促20余天"为主诉入院。入院前曾误诊为"慢性咽炎、慢性支气管炎、支气管哮喘"。入院查胸部CT显示双肺可见广泛性肺间质改变,并出现散在斑片影,边界模糊,部分病灶呈磨玻璃样。经纤维支气管镜于右肺下叶基底段肺活检(TBLB):肉芽肿炎伴小灶性坏死,考虑结核。异烟肼、利福平、吡嗪酰胺、乙胺丁醇(HRZE)规则抗结核治疗后,咳嗽、气促渐缓解,病灶渐吸收,随访至今29个月,未见复发。在万方医学数据库上检索到相关文献13篇,1例为个案报道,其余多为误诊分析或影像表现研究;在Pub Med数据库检索,国外未见相关报道。结论以间质性改变为主要表现的肺结核好发于中青年男性,亚急性病程,临床症状不典型,以咳嗽、呼吸困难、发热最为常见,胸部CT是早期诊断的关键,网格样改变、小叶间隔增厚、小叶中心性结节、胸膜受累、树芽状是活动性间质性肺结核主要影像学表现。当与肺部弥漫性疾病难以鉴别时,经纤维支气管镜及CT引导下肺穿刺术取得组织病理学是诊断的关键,必要时可考虑行外科开胸活检术。