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1 病例介绍 患者 女,55岁,因咳大量浆液性泡沫痰6月余,伴气促2月余来诊。自述6个月前无明显诱因咳白色泡沫样痰,并逐渐增多,但无发热、胸痛、胸闷及咯血等症状。在当地医院拍胸片示“左肺中下野大片状阴影,密度不均,边缘模糊”,诊断为“左侧肺炎”。予以氨苄青霉素、苯唑青霉素等治疗2周后,病情无缓解,且痰量逐渐增多。后到市级医院行CT检查和支气管镜检,发现左肺后段和背段有较多水样泡沫痰,粘膜充血。支气管灌注未见肿瘤细胞,灌洗液细胞分类:巨噬细胞0.77,淋巴细胞0.05,中性分叶核0.17,嗜酸细胞0.01。进行抗炎治疗(丁胺卡那霉素和特丽仙等)3周痰量继续增多,每日“约半痰盂”,并出现气促。后到省级医院就诊,拍胸片示除左肺大片密度增高阴影外,右肺中野亦出现大片阴影。诊断为双肺肺泡病变,炎症可能性大。给予氧氟
A case description The female patient, 55 years old, due to cough large serous foam sputum more than 6 months, accompanied by shortness of breath more than 2 months to visit. Readme 6 months ago no obvious incentive cough white foam-like sputum, and gradually increased, but no fever, chest pain, chest tightness and hemoptysis and other symptoms. In the local hospital shot chest radiograph showed “left lung large flaky shadows, uneven density, blurred edges,” diagnosed as “left pneumonia.” After 2 weeks of treatment with ampicillin, oxacillin, the disease did not relieve and sputum volume gradually increased. After the city-level hospital CT examination and bronchoscopy, found that the back of the left lung and back more watery foam sputum, mucosal hyperemia. No tumor cells were found in bronchial infusions. Lavage fluid cells were classified as macrophages 0.77, lymphocytes 0.05, neutral lobes 0.17 and eosinophils 0.01. For anti-inflammatory treatment (amikacin and Trichosanthin, etc.) 3 weeks sputum volume continued to increase daily “about half spittoon”, and the emergence of shortness of breath. After the visit to the provincial hospital, take a chest radiograph in addition to large densities of the left lung shadow increased, the right lung also appears large shadow Nakano. Diagnosis of pulmonary alveolar lesions, the possibility of inflammation. Oxyfluoride is given