BMJ:一例疑似咳嗽和上呼吸道感染患者

2016-04-16 MedSci MedSci原创

女性患者,82岁,因出现发痒咳嗽和上呼吸道感染症状而就诊。其血氧饱和度正常,也没有其他的系统性疾病。然而,患者有结核病病史,且多年前曾接受手术治疗,具体手术未知。经检查,医生发现患者右肺尖处呼吸声降低,建议胸部摄影检查。胸片显示如下(图1⇓)

女性患者,82岁,因出现咽喉发痒咳嗽和上呼吸道感染症状而就诊。其血氧饱和度正常,也没有其他食物系统性疾病。然而,患者有结核病病史,且多年前曾接受手术治疗,具体手术未知。经检查,医生发现患者右肺尖处呼吸声降低,建议胸部摄影检查。胸片显示如下(图1⇓)




诊断:患者右肺尖上部存在曾用来治疗肺结核的油胸。

讨论:没有任何迹象或其他病因显示患者的症状为上呼吸道感染所致。



患者右侧肺尖处可见油胸(图2⇓,箭头),边界清楚,周边部分钙化。病灶为圆形,有囊壁围绕,位于胸膜外。挤压相邻的肋骨,导致肋骨拥挤,由于长期的体积损失使得肋骨变得纤细。右肺上叶体积丧失的其他可见特征包括右肺门上移和纵隔右移。

油胸曾作为一种治疗方式用于治疗肺结核,是将油注入胸膜腔以压缩下面的肺。是压缩肺结核空洞的一种方法,正如这个病例所示,在今天仍可看到接受此治疗的患者。其他的挤压式方法包括充填术,胸廓成形术,膈神经压榨术和人工气胸。

原始出处:

David C Howlett,  Joseph Dalby Sinnott, Mild cough and decreased breath sounds in an 82 year old woman. BMJ 2016; 353 doi: http://dx.doi.org/10.1136/bmj.i2080 (Published 15 April 2016)

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    2016-08-05 gaoxiaoe
  2. [GetPortalCommentsPageByObjectIdResponse(id=1847959, encodeId=6aee184e95933, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Fri Aug 05 01:26:00 CST 2016, time=2016-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1282378, encodeId=8dc312823e8fd, content=<a href='/topic/show?id=700239e0772' target=_blank style='color:#2F92EE;'>#呼吸道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39707, encryptionId=700239e0772, topicName=呼吸道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e94174, createdName=zhmscau, createdTime=Mon Apr 18 11:26:00 CST 2016, time=2016-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79229, encodeId=c321e922944, content=学习了,谢谢!, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c99e1650061, createdName=1ddc5e95m01(暂无匿称), createdTime=Sun Apr 17 11:36:00 CST 2016, time=2016-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79221, encodeId=c56ce92219d, content=文章不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Sun Apr 17 11:16:00 CST 2016, time=2016-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79222, encodeId=fc20e9222cc, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Sun Apr 17 11:16:00 CST 2016, time=2016-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79205, encodeId=c864e9205e1, content=学习了,值得, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=387d1660055, createdName=dhzzm, createdTime=Sun Apr 17 10:21:00 CST 2016, time=2016-04-17, status=1, ipAttribution=)]
    2016-04-18 zhmscau
  3. [GetPortalCommentsPageByObjectIdResponse(id=1847959, encodeId=6aee184e95933, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Fri Aug 05 01:26:00 CST 2016, time=2016-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1282378, encodeId=8dc312823e8fd, content=<a href='/topic/show?id=700239e0772' target=_blank style='color:#2F92EE;'>#呼吸道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39707, encryptionId=700239e0772, topicName=呼吸道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e94174, createdName=zhmscau, createdTime=Mon Apr 18 11:26:00 CST 2016, time=2016-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79229, encodeId=c321e922944, content=学习了,谢谢!, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c99e1650061, createdName=1ddc5e95m01(暂无匿称), createdTime=Sun Apr 17 11:36:00 CST 2016, time=2016-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79221, encodeId=c56ce92219d, content=文章不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Sun Apr 17 11:16:00 CST 2016, time=2016-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79222, encodeId=fc20e9222cc, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Sun Apr 17 11:16:00 CST 2016, time=2016-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79205, encodeId=c864e9205e1, content=学习了,值得, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=387d1660055, createdName=dhzzm, createdTime=Sun Apr 17 10:21:00 CST 2016, time=2016-04-17, status=1, ipAttribution=)]
    2016-04-17 1ddc5e95m01(暂无匿称)

    学习了,谢谢!

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1847959, encodeId=6aee184e95933, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Fri Aug 05 01:26:00 CST 2016, time=2016-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1282378, encodeId=8dc312823e8fd, content=<a href='/topic/show?id=700239e0772' target=_blank style='color:#2F92EE;'>#呼吸道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39707, encryptionId=700239e0772, topicName=呼吸道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e94174, createdName=zhmscau, createdTime=Mon Apr 18 11:26:00 CST 2016, time=2016-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79229, encodeId=c321e922944, content=学习了,谢谢!, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c99e1650061, createdName=1ddc5e95m01(暂无匿称), createdTime=Sun Apr 17 11:36:00 CST 2016, time=2016-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79221, encodeId=c56ce92219d, content=文章不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Sun Apr 17 11:16:00 CST 2016, time=2016-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79222, encodeId=fc20e9222cc, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Sun Apr 17 11:16:00 CST 2016, time=2016-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79205, encodeId=c864e9205e1, content=学习了,值得, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=387d1660055, createdName=dhzzm, createdTime=Sun Apr 17 10:21:00 CST 2016, time=2016-04-17, status=1, ipAttribution=)]
    2016-04-17 李继凯

    文章不错

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1847959, encodeId=6aee184e95933, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Fri Aug 05 01:26:00 CST 2016, time=2016-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1282378, encodeId=8dc312823e8fd, content=<a href='/topic/show?id=700239e0772' target=_blank style='color:#2F92EE;'>#呼吸道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39707, encryptionId=700239e0772, topicName=呼吸道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e94174, createdName=zhmscau, createdTime=Mon Apr 18 11:26:00 CST 2016, time=2016-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79229, encodeId=c321e922944, content=学习了,谢谢!, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c99e1650061, createdName=1ddc5e95m01(暂无匿称), createdTime=Sun Apr 17 11:36:00 CST 2016, time=2016-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79221, encodeId=c56ce92219d, content=文章不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Sun Apr 17 11:16:00 CST 2016, time=2016-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79222, encodeId=fc20e9222cc, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Sun Apr 17 11:16:00 CST 2016, time=2016-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79205, encodeId=c864e9205e1, content=学习了,值得, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=387d1660055, createdName=dhzzm, createdTime=Sun Apr 17 10:21:00 CST 2016, time=2016-04-17, status=1, ipAttribution=)]
    2016-04-17 李继凯

    值得学习

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1847959, encodeId=6aee184e95933, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Fri Aug 05 01:26:00 CST 2016, time=2016-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1282378, encodeId=8dc312823e8fd, content=<a href='/topic/show?id=700239e0772' target=_blank style='color:#2F92EE;'>#呼吸道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39707, encryptionId=700239e0772, topicName=呼吸道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e94174, createdName=zhmscau, createdTime=Mon Apr 18 11:26:00 CST 2016, time=2016-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79229, encodeId=c321e922944, content=学习了,谢谢!, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c99e1650061, createdName=1ddc5e95m01(暂无匿称), createdTime=Sun Apr 17 11:36:00 CST 2016, time=2016-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79221, encodeId=c56ce92219d, content=文章不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Sun Apr 17 11:16:00 CST 2016, time=2016-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79222, encodeId=fc20e9222cc, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Sun Apr 17 11:16:00 CST 2016, time=2016-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79205, encodeId=c864e9205e1, content=学习了,值得, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=387d1660055, createdName=dhzzm, createdTime=Sun Apr 17 10:21:00 CST 2016, time=2016-04-17, status=1, ipAttribution=)]
    2016-04-17 dhzzm

    学习了,值得

    0

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