闭塞性细支气管机化性肺炎

闭塞性细支气管机化性肺炎(bronchiolitis obliterans organizing pneumonia,BOOP)是一个临床病理术语,其特征是以细支气管腔、肺泡管以及一些肺泡有肉芽组织形成,伴有间质和气腔内不同程度的单核细胞和泡沫巨噬细胞的浸润[1-2].     

Bronchiolitis obliterans organizing pneumonia

Bronchiolitis obliterans with organizing pneumonia (BOOP) is now established as a distinct clinicopathologic entity, yet it may be overlooked by clinicians due to unfamiliarity and its non-specific presentation. It can be either idiopathic or associated with a variety of causes, such as infections, drugs, radiation or connective tissue diseases. A lung biopsy is needed to provide histopathologic confirmation. Usually prognosis is good, and the response to steroids may be dramatic, but occasionally BOOP may be fatal or runs a chronic relapsing course. This article is an updated review on current knowledge regarding BOOP.     

Rapidly-progressive bronchiolitis obliterans organising pneumonia

Bronchiolitis obliterans organising pneumonia is a clinicopathological syndrome characterised by indolent course of flu-like illness followed by cough, dyspnoea and fever, and responds well to steroid treatment. We describe a 76-year-old woman who presented with a short three-day history and progressed rapidly to respiratory failure. She was successfully treated with high-dose steroids.     

Bronchiolitis obliterans organizing pneumonia associated with pseudomonas aeruginosa infection

Bronchiolitis obliterans organizing pneumonia is a rare disease characterized by the presence of granulation tissue within alveolar ducts and alveoli. Most cases are idiopathic, but it may also be seen during resolution of viral or bacterial pneumonia (mycoplasma, legionella and chlamydia). It may present as a community acquired pneumonia which does not respond to antibiotics, which make the diagnosis very difficult. We described a 53-year old patient who presented with Bronchiolitis obliterans organizing pneumonia during the resolution of pseudomonas aeruginosa pneumonia. Initially there was slight improvement on antibiotics but later he became severely hypoxic and placed on mechanical ventilator. Diagnosis of Bronchiolitis obliterans organizing pneumonia was obtained with bronchoscopic lung biopsy. He showed an excellent response to steroid treatment. To our knowledge this is the first case of Bronchiolitis obliterans organizing pneumonia secondary to Pseudomonas aeruginosa pneumonia.     

滤泡性淋巴瘤合并副肿瘤性天疱疮和闭塞性细支气管炎1例报告

1 病例资料 患者女,56 岁,因"口腔溃疡伴盗汗、体重减轻近1 个月、全身多发淋巴结肿大1 周"于2019 年8 月1 日入住海军军医大学(第二军医大学)长海医院血液科.患者于2019 年6 月初无明显诱因出现口腔黏膜溃疡,伴盗汗、体重减轻,无发热、皮疹、关节痛、胸闷、吞咽困难等不适.2019 年6 月21 日于外院就诊,予地塞米松片口服、碳酸氢钠溶液和康复新液漱口、开喉剑喷雾剂外用,口腔溃疡无好转.     

隐源性机化性肺炎一例并文献复习

结合我科1例隐源性机化性肺炎(COP),复习2003年至2008年国内COP文献,了解目前国内COP的临床表现及诊断现状.结果 显示COP的主要临床表现是发热、咳嗽、呼吸困难,影像学多见实变和磨玻璃样变,易误诊为肺炎;目前主要的诊断手段是肺活组织检查;其主要的病理变化是呼吸性细支气管和小气道、肺泡腔内息肉状肉芽组织增生.     

隐源性机化性肺炎一例并文献复习

结合我科1例隐源性机化性肺炎(COP),复习2003年至2008年国内COP文献,了解目前国内COP的临床表现及诊断现状.结果 显示COP的主要临床表现是发热、咳嗽、呼吸困难,影像学多见实变和磨玻璃样变,易误诊为肺炎;目前主要的诊断手段是肺活组织检查;其主要的病理变化是呼吸性细支气管和小气道、肺泡腔内息肉状肉芽组织增生.     

隐源性机化性肺炎1例并文献复习

目的提高对隐源性机化性肺炎的认识.方法 分析我院2009年5月收治的1例隐源性机化性肺炎(COP)的临床、影像和病理资料及治疗方法,并复习相关文献.结果 COP临床表现、影像学均缺乏特异性,病理有相对特异性改变,COP经支气管肺活检(TBLB)可明确诊断.结论 TBLB可获得满意的肺组织标本,可作为获取标本的首选方式....     

隐源性机化性肺炎一例并文献复习

结合我科1例隐源性机化性肺炎（COP）,复习2003年至2008年国内COP文献,了解目前国内COP的临床表现及诊断现状。结果显示COP的主要临床表现是发热、咳嗽、呼吸困难,影像学多见实变和磨玻璃样变,易误诊为肺炎;目前主要的诊断手段是肺活组织检查;其主要的病理变化是呼吸性细支气管和小气道、肺泡腔内息肉状肉芽组织增生。     

Saddle pulmonary embolus and bronchiolitis obliterans with organizing pneumonia develop simultaneously after first cyclophosphamide,methotrexate, 5FU chemotherapy for breast cancer

A 62-year-old woman underwent a right mastectomy with axillary node dissection for a poorly differentiated ductal carcinoma. One month later, she underwent a left nephrectomy for a renal cell carcinoma. Two weeks after, she received her first cycle of cyclophosphamide, methotrexate, and 5FU (CMF) as a part of her breast cancer treatment. We describe an unusual case of non-occlusive saddle pulmonary embolus with extensive bilateral deep vein thrombosis and severe bronchiolitis obliterans with organizing pneumonia developing simultaneously after the first CMF chemotherapy for breast cancer.Pulmonary embolism (PE) is a serious condition that commonly develops in hypercoagulable states such as malignancy and post chemotherapy treatment.1 When associated with hemodynamic instability, immediate recognition, and treatment are essential for a favorable outcome.2 Elevated pulmonary artery pressures (PAP) and pulmonary vascular resistance (PVR) may be the clue to diagnosis and subsequently the treatment of PE.3 Bronchiolitis obliterans with organizing pneumonia (BOOP) is another serious disease that is frequently misdiagnosed and is associated with significant morbidity and mortality. Early recognition and treatment usually leads to better outcomes.4 The objective in presenting this particular case is to describe a rare case of significant pulmonary embolism and severe BOOP developing simultaneously after the first cyclophosphamide, methotrexate, 5FU (CMF) chemotherapy for breast cancer.     

儿童闭塞性细支气管炎临床分析

目的了解小儿闭塞性细支气管炎(BO)的临床特点.方法对近年本院临床诊断为BO的6例病例进行临床表现、胸部X线及高分辨CT、肺功能和治疗转归的回顾性分析.结果 6例均表现为呼吸道感染后慢性咳嗽、喘息、气促,1例病程4周以上,其余5例病程8～16周以上.查体:均有呼吸急促,双肺闻及湿啰音、喘鸣音.X线胸片:肺内过度通气6例,斑片状磨玻璃影1例.胸部高分辨CT:斑片影5例,Mosaic灌注5例,支气管壁增厚2例.肺功能:6例均为阻塞性通气功能障碍,非可逆性,5例血气示氧分压降低.2例纤维支气管镜检查无特异性发现.6例患儿用支气管舒张剂治疗无效,随后均用激素治疗,3例已随访6～8个月,2例病情改善,肺内啰音消失,肺过度充气减轻,其中1例肺CT Mosaic灌注有所好转,另1例肺CT无明显改善.第3例病情及肺CT均无明显改善.结论 BO的临床表现以慢性咳嗽、喘息,肺内有喘鸣音为特点,对支气管舒张剂无反应.肺CT示:Mosaic灌注、支气管壁增厚等.X线胸片和纤维支气管镜检查无特异性.肺功能为阻塞性通气功能障碍,不可逆性.血气显示不同程度的低氧血症.BO的诊断主要依据典型的临床表现、肺部高分辨CT和肺功能检查.     

婴幼儿闭塞性细支气管炎的肺功能改变

目的 观察婴幼儿闭塞性细支气管炎的肺功能变化情况. 方法 应用婴幼儿体描仪,对46例患闭塞性细支气管炎婴幼儿于吸入沙丁胺醇前后进行肺功能检测. 结果 46例患儿吸入沙丁胺醇前潮气呼吸流速-容量环呼气降支凹陷;达峰容积比(VPEF/VE)、达峰时间比(tPTEF/tE)、吸呼气时间比(ti/te)和每千克体重呼吸系统顺应性(Crs/kg)降低;呼吸系统阻力(Rrs)和每千克体重功能残气量(FRC/kg)增加;而中期流速比(TEF50/TIF50)有18例降低,28例正常.46例患儿吸入沙丁胺醇后达峰容积比、达峰时间比等肺功能指标均无明显改善. 结论 婴幼儿闭塞性细支气管炎肺功能是以小气道为主的阻塞性通气功能障碍,舒张试验阴性.肺功能测定能很好地反映本病病情.     

MSCT诊断机化性肺炎的临床价值

目的分析机化性肺炎的CT表现特点及其诊断价值。方法分析24例经病理证实的机化性肺炎(OP)的临床资料和影像学表现。结果 CT显示绝大多数病灶位于两肺周围带,边缘不规则,形态从圆形到多边形,17例可见充气支气管征,边缘有长毛刺17例,2例有空洞,18例胸膜增厚,12例有支气管血管束的增粗和聚拢。结论机化性肺炎与周围性肺癌、肺结核的CT表现存在较多相似之处,诊断和鉴别诊断较困难,但有一定的特征性,CT诊断符合率较高。