案例322 问题322
Jiun-Yiing Hu1, Kyung Hee Lee1, Gabin Yun1
1From the Department of Radiology (J.Y.H., G.Y.) and Department of Radiology, Division of Cardiothoracic Imaging (G.Y.), University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213; and Department of Radiology, Bundang Seoul National University Hospital, Seoul, South Korea (K.H.L.).
Radiology
|October 31, 2023
概括
一个有结核病史的81岁老人出现了恶化的胸痛和呼吸障碍. 先进的成像和活检证实了胸部病变,导致适当的治疗.
科学领域:
- 肺部病理学 肺部病理学
- 在瘤学瘤学.
- 传染性疾病 传染性疾病
背景情况:
- 一名81岁的男性有尿道癌,膀瘤和结核性多病史,出现了新发的胸痛和呼吸不良.
- 最初的CT显示胸部病变,活检显示慢性活性炎症.
- 该患者最近完成了对活跃结核病的治疗.
研究的目的:
- 为了评估患有结核病和癌症史的患者中正在增长的胸部病变.
- 为了确定持续的呼吸道症状和白细胞病的病因.
主要方法:
- 系列对比增强的胸部CT扫描.
- 胸部损伤的CT导向活检.
- 肝脏的MRI. 肝脏的MRI. 肝脏的MRI. 肝脏的MRI.
- 通过PET/CT扫描.
- 实验室检测包括全血细胞计和C反应蛋白.
- 唾液培养. 唾液培养. 唾液培养. 唾液培养.
主要成果:
- 最初的活检显示慢性活性炎症;唾液培养对结核病是负的.
- 随后的CT显示了病变的间隔增长.
- 症状恶化和炎症标志物 (白细胞病,C-反应蛋白) 的升高被注意到.
- 重复活检和PET/CT证实了诊断.
结论:
- 患有肺结核病史的患者的胸部病变可能会带来诊断挑战.
- 高级成像和重复活检对于初步发现不确时的准确诊断至关重要.
- 及时诊断和治疗对于管理复杂的胸腔病理至关重要.
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