常记溪亭日暮,沉醉不知归路。
公众号:小小医生之有趣的医学
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肺大泡,很简单,但是复杂的时候:最简单的也是最复杂的。
01
肺大泡!
so easy!
02 肺功能
A pulmonary function test showed mild obstructive impairment; however, the vital capacity and diffusing capacity were normal.
肺功能:轻度阻塞性损伤;肺活量和弥散量正常。
03 化验单
血清类风湿因子、抗核抗体、抗ss - a抗体水平升高,抗ss - b抗体水平正常。
An elevation of the serum rheumatoid factor and antinuclear and anti-SS-A antibody levels was observed, while the serum anti-SS-B antibody level was normal.
04 仔细看CT
有结节。
还有结节。
肺淋巴管平滑肌瘤病?
肺朗格汉斯组织细胞增生症?
淋巴细胞性间质性肺炎?
这个“肺大泡”的壁,有一小丁点厚,外形不够圆:只可意会不可言传。
事后诸葛亮:大人,此事有蹊跷!
下面这个CT,看着可能是肺囊肿,但是,外科手术切下来,病理:肺大泡。
肺大泡与肺囊肿,很难鉴别,非常难。
相关阅读:
CT基础:肺大泡、肺气肿、肺的气囊、囊肿、空洞,CT如何鉴别
05 派特CT
Fluorodeoxyglucose-positron emission tomography did not demonstrate a high uptake level of the standard uptake value。
派特CT未见异常。真有钱,这就拉去做派特CT。
06 气管镜
Flexible bronchoscopy disclosed no abnormal findings in the trachea or bronchi。
The histopathology of the specimens obtained with a transbronchial lung biopsy (TBLB) showed no specific findings.
气管镜:未见异常。经支气管镜肺活检:无特殊发现。
在中国,派特CT自费6000多(以前约1万元),气管镜+肺活检也1000多元,啥都没有发现,白白浪费了病人的钱,还受罪。
07 肿么办?
Therefore, lung biopsy specimens of the right S2 and S8 were obtained via video-assisted thoracoscopic surgery (VATS). The histopathology of the specimens (Fig. 2) revealed infiltration of small- and middlesized lymphocytes, follicular colonization and the presence of lymphoepithelial lesions with a large amount of proliferation of lymphocytes around the bronchovascular bundles and bronchioles. The lymphocytes were immunohistochemically positive for CD20 and CD138 and negative for CD3 and exhibited a monoclonal expression ofλ-chain. These findings were consistent with a diagnosis of mucosa-associated lymphoid tissue (MALT) lymphoma.
外科胸腔镜肺活检,病理:肺粘膜相关淋巴瘤。
08
在本例中,血清RF和抗核抗体和抗ss - a抗体水平升高;然而,没有主观症状,包括唾液或泪腺分泌水平下降。因此,本病例不符合Sjögren综合征的诊断标准。
There was a lack of evidence of extrapulmonary involvement for three months after diagnosis, and the patient was diagnosed with primary p-MALT lymphoma. She has not received any chemotherapy, and her clinical symptoms and radiologic findings have been stable for two years.
诊断后3个月无肺外受累迹象,患者被诊断为原发性p-MALT淋巴瘤。
她没有接受任何化疗,她的临床症状和放射学表现稳定了两年。
Noguchi S, Yatera K, Kido T,et al. Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma with multiple thin-walled pulmonary cysts: a case report and review of the literature. Intern Med. 2013;52(20):2325-9.
Bae et al. (5) showed that the chest CT findings of p-MALT lymphoma consist of single nodular or consolidative patterns (33%), multiple nodules or areas of consolidation (43%), bronchiectasis and bronchiolitis (14%) and diffuse interstitial lung disease (10%).
Bae等(5)发现p-MALT淋巴瘤的胸部CT表现包括:单发结节或实变类型(33%)、多发结节或实变区域(43%)、支气管扩张和细支气管炎(14%)和弥漫性间质性肺疾病(10%)。
09 学习视频
10
杨柳岸,晓风残月。
视频
这感觉也不能怪她,是我我也憋不住。
蜘蛛侠电影盘点。
三国群聊(7):华佗再治曹操,暗杀司马懿!
大葱看电影:雄狮少年。
陈翔六点半:兄弟,来搬砖不,我觉得你挺会抬杠的。
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