lemon2008 发表于 2012-12-24 20:58:04


History:Man with cough.

lemon2008 发表于 2012-12-24 20:59:35

Granulomatous infection肉芽肿性感染

lemon2008 发表于 2012-12-24 21:02:43


lemon2008 发表于 2012-12-24 21:05:34

A. Primary tuberculosis.原发型肺结核
B. Reactivation tuberculosis.活动性肺结核
C. PCP pneumonia.PCP肺炎
D. Cryptococcus. 隐球菌感染
E. Invasive aspergillosis.侵袭性曲霉病

lemon2008 发表于 2012-12-24 21:35:59



Additional clinical history:Forty-year-old homeless man with cough.其他临床病史:男性,40岁,咳嗽

Chest radiograph:Patchy airspace consolidation in the bilateral upper lobes and perihilar regions bilaterally.Multifocal nodular opacities in the peripheral right upper lobe, left perihilar region, and lateral left upper lobe.
CT Chest:Multifocal areas of airspace consolidation and scattered multinodular opacities involving both lungs, most pronounced in the upper lobes and superior segments of the lower lobes.Small eccentric cavitation in the left upper lobe consolidation.Bronchial wall thickening, centrilobular nodules, tree-in-bud pattern, scattered peribronchial infiltrates and acinar nodules, particularly in the dependent portions of the lungs, compatible with endobronchial spread.

Differential diagnosis:
Post-primary pulmonary tuberculosis继发性肺结核
Chronic fungal infection (histoplasmosis, coccidiomycosis) 慢性真菌感染(组织胞浆菌病,球孢子菌病)
Ankylosing spondylitis 强直性脊柱炎
Progressive massive fibrosis 重度肺纤维化
Sarcoidosis (late stage) 结节病(晚期)
Bronchogenic carcinoma支气管肺癌

Diagnosis:Post-primary tuberculosis

lemon2008 发表于 2012-12-24 21:39:47

Key points:
[*]Post-primary tuberculosis继发性肺结核

[*]Results from reactivation of a previously dormant primary infection (90% of cases) or represents continuation of the primary disease (minority of cases)
[*]Almost exclusively a disease of adolescence and adulthood
[*]Risk factors: impaired cellular immunity (HIV+, elderly, homeless, prisoners, indigent)
[*]Radiographic findings include:

[*]Airspace consolidation (lobular sized and peribronchial)
[*]Cavitations with variable wall thickness
[*]Endobronchial spread to dependent portions of lung (centrilobular nodules, tree-in-bud appearance, bronchial wall thickening)
[*]Other findings: fibrotic changes, volume loss, adenopathy, pleural effusions
[*]Distribution: often segmental, apical and apical posterior segments of upper lobes and superior segments of lower lobes, gravity dependent lobes (via bronchogenous spread)
[*]Signs of active disease: signs of endobronchial spread, cavitation, consolidation
[*]Inactive disease: requires stability over 6 months
[*]Sequela: Consolidation and nodules resolve over 9-12 months with successful treatment. May see signs of fibrosis, volume loss, calcifications of lung and lymph nodes
[*]If immunosuppressed, may progress to miliary tuberculosis, ARDS, extrathoracic dissemination to breast, spine, kidney, meninges, bone

[*]Harisinghanai, MG. et al. Tuberculosis from Head to Toe RadioGraphics, 20, 449-470. March 2000.
[*]Winer-Muran, Helen. Statdx.com: "Post-Primary Tuberculosis" Accessed December 2010.

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