[醫(yī)藥衛(wèi)生]chest

《[醫(yī)藥衛(wèi)生]chest》由會(huì)員上傳分享，免費(fèi)在線閱讀，更多相關(guān)內(nèi)容在應(yīng)用文檔-天天文庫。

1、SOLITARYPULMONARYNODULE1.A40-year-oldmalesmokerpresentswithahistoryofchroniccough.HehashadsymptomsofanupperrespiratoryillnessforafewmonthssincevisitingfamilyinArizona.Physicalexamisnormal.CXRisshownbelowinFig.1.Thenextstepinmanagementshouldbea.Completepulmonaryfunctiontestsb.Fiberopticbronchos

2、copyc.Percutaneousneedlebiopsyd.ObservationandrepeatCXRin6to8moFigure1.Thischestx-rayshowsaradiographicallydensenoduleinthelefthilum.Cardiophrenicandcostophrenicanglesareclear.An0.8×1-cmcircularsolitarypulmonarynodulewithperipheralyetdistinctcalcificationinthesuperioraspectisseenoverlyingthe5t

3、hposteriorribintherightupperlungzone.1.Theanswerisc.Basedontheageofthepatient,riskfactors,andpersistentsymptoms,furtherdiagnostictestsarewarranted.Observationfor6moisinappropriate.Duetotheperipheralnatureofthislesion,aCT-guidedneedlebiopsywouldbethebestdiagnosticstrategyandhaveabetteryieldthan

4、abronchoscopy.Pulmonaryfunctiontestswouldbehelpfulifsurgeryisplanned,butwouldnotalterthediagnosticsteps.Inthiscase,theCT-guidedbiopsyrevealedcoccidioidomycosis.Thisiscausedbyafungus(Coccidioidesimmitis)inthesoilandisseenindesertsemiaridclimateswithashort,intenserainyseason.Itisendemicinsouthwe

5、sternNorthAmerica,Mexico,andCentralandSouthAmerica.Mostpatientsareasymptomaticorrecoverfullyafterinitialflulikeillness.Theradiographicfindingsofcoccidioidomycosisarevariableanddependupontheseverityofthedisease.Mostgranulomasaresmallerthan2cm,andalmostallarelessthan3cminsize.BesidesSPNs,intheea

6、rlystagesofcoccidioidomycosispatchyinfiltratesmaybeaccompaniedbyhilarandmediastinaladenopathyandlessfrequentlybypleuraleffusion.Incasesofpersistentdisease,infiltratesmayenlarge.Items2–3A34-year-oldwoman,arecentimmigrantfromEasternEurope,isseenwithcomplaintsofvaguechestdiscomfortafteranupperres

7、piratorytractinfection.SheisnotasmokerandgivesahistoryofBCGvaccination卡介苗接種whenshewasaninfant.Physicalexaminationisnormal.PPDis10-mminduration硬結(jié)andinducedsputumforacid-fastbacilliisnegative.CXRisshowninFig.2.2.Whatisthemostlikelydiagnos