病例挑战:咳嗽、咯痰、喘息3 月余, 加重10余天

2021-05-13 网络 网络

科室:呼吸

科室:呼吸
体温:36.9
血压:120 60 mmHg
性别:女
年龄:20
心率:100
呼吸频率:20
脉搏:100
主诉:
咳嗽、咯痰、喘息3 月余, 加重10余天
现病史:
3 个月前无明显诱因出现咳嗽、咯痰、喘息, 于当地医院行胸部C T 检查,C T 示右肺中叶、左肺舌叶支气管 扩张并感染, 诊断为“支气管扩张合并感染、双肺细支气管炎” , 给予抗炎(阿奇霉素、左氧氟沙星、头孢地尼) 等对症治疗后症状有所好转。10 余天前患者无明显诱因咳嗽、咯痰、喘息症状加重, 于当地医院就诊。X 线 胸片示双肺纹理结构异常, 中下肺野为著;胸部CT 示双侧肺野散在分布均一的高密度小结节。 考虑双肺感染、粟粒性肺结核? 故行痰抗酸杆菌检查、PPD 试验、抗中性粒细胞胞浆抗体检测等, 结果均为 阴性。诊断:肺部病变性质待查? 为进一步诊治就诊于我院, 以“喘憋待查”收入院。
既往史:
自述“支气管哮喘”病史10 余年, 未规律诊治, 喘息加重时抗炎、平喘治疗有效;否认结核病接触史。
个人史:
原籍出生长大,否认到过疫区和疫水接触史,否认有毒物质、放射性物质接触史,否认嗜烟酒及其它不良嗜好。

婚姻史:未婚未育
家族史:否认家族遗传病史

月经婚育史:14(4-6/28-29)量中等,未见血块,经期前后无不适,无痛经。

 

病例解析

原发性纤毛运动障碍(PCD)又称纤毛不动综合征,属常染色体隐性遗传,是各种遗传性原发纤毛结构缺陷引起的纤毛功能异常,常见的是呼吸道纤毛功能异常,引起反复的呼吸道感染。原发性纤毛运动障碍包括纤毛不动综合征、Kartagener综合征,纤毛运动不良和原发性纤毛定向障碍等几种类型。PCD中50%的病例合并内脏转位,形成Kartagener综合征。

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    2021-09-29 呼吸科小医生

    学习了,谢谢分享!

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1056259, encodeId=3f551056259c1, content=学习了,谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210612/4cac76eb29134c3aa63a2560971ec878/648fa1cb22cd430380c051eb0a8f6259.jpg, createdBy=7a8d5519826, createdName=呼吸科小医生, createdTime=Wed Sep 29 20:56:32 CST 2021, time=2021-09-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=968362, encodeId=d931968362f9, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f49b5500111, createdName=博君一肖, createdTime=Tue May 25 12:58:20 CST 2021, time=2021-05-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=965219, encodeId=aa8796521931, content=请问这个病需要如何治疗, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211127/5a0308cbb6df4988a39bb2e9cd742574/8d8f90119ae44a069e959d1f315203c9.jpg, createdBy=362e5500190, createdName=井水, createdTime=Thu May 13 15:06:32 CST 2021, time=2021-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=965142, encodeId=ef1196514253, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bd942263182, createdName=Blackblue, createdTime=Thu May 13 10:14:41 CST 2021, time=2021-05-13, status=1, ipAttribution=)]
    2021-05-25 博君一肖

    学习

    0

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    2021-05-13 井水

    请问这个病需要如何治疗

    0

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    2021-05-13 Blackblue

    学习

    0