痰中带血伴肺内结节和空洞性病变

本文报道1例中年男性患者,主因"间断咳嗽、咳痰、痰中带血1年"就诊。患者血清自身抗体阴性。病程初期于外院查胸部CT可见右肺中叶结节伴空洞形成,行手术切除病灶,术后病理诊断炎性假瘤,未予治疗后症状再发,复查胸部CT新见右肺上叶斑片实变影,上级医院会诊手术病理见血管炎改变,考虑诊断肉芽肿性多血管炎,加用激素治疗后病情仍逐渐进展,北京协和医院会诊病理诊断肺放线菌病,经抗感染治疗后病灶吸收。本患者的诊治过程加深了临床医师及病理科医师对感染与血管炎关系的理解。

Bloody sputum with cavitary lesions on chest computed tomography scans:a case report

This article reported a case of a middle-aged man with a 1-year history of intermittent cough and production of bloody sputum.Serum autoantibodies of the patient were negative.Early in the course of the disease,chest computed tomography(CT)scans showed a nodule in the right middle lung lobe with cavity formation.Surgical resection of the lesion was done with a postoperative pathological diagnosis of inflammatory pseudotumor.No treatment was given and his symptoms recurred with new patches in the right upper lobe.Pathology consultation from another hospital found vasculitis under the microscope and a diagnosis of granulomatosis with polyangiitis was made.His symptoms still worsened after glucocorticoid therapy.Final pathological consultation from Peking Union Medical College Hospital reached a diagnosis of pulmonary actinomycosis.Pulmonary lesions were absorbed after anti-infection treatment.The diagnosis and treatment of this patient provided more data for understanding of the relationship between infection and vasculitis among clinicians and pathologists.