肺部阴影伴血嗜酸性粒细胞升高1例  

Cough,bloody sputum,eosinophil elevation and lung shadow

作　　者：李玉红 罗金梅[1] 张婷[1] 高莉 宋兰[4] 彭敏[1] 刘鸿瑞[5] 许文兵[1] 刘正印 施举红[1] 冯瑞娥[5] Li Yuhong;Luo Jinmei;Zhang Ting;Gao Li;Song Lan;Peng Min;Liu Hongrui;Xu Wenbing;Liu Zhengyin;Shi Juhong;Feng Ruie(Department of Respiratory and Critical Care Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Respiratory and Critical Care Medicine,Qinghai University Affiliated Hospital,Xining 810001,China;Department of Radiology,Peking University First Hospital,Beijing 100034,China;Department of Radiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Pathology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Infectious Disease,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院呼吸与危重症医学科,北京100730 [2]青海大学附属医院呼吸与危重症医学科,西宁810001 [3]北京大学人民医院医学影像科,北京100034 [4]中国医学科学院北京协和医院放射科,北京100730 [5]中国医学科学院北京协和医院病理科,北京100730 [6]中国医学科学院北京协和医院感染科,北京100730

出　　处：《中华结核和呼吸杂志》2022年第12期1231-1236,共6页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：患者男,47岁,间断咳嗽、咳痰2年,加重伴右侧胸痛、血痰3个月入院。患者入院前2年(2014年)出现咳嗽、咳白痰、轻微胸痛,查胸部CT提示右上肺2 cm×2 cm圆形低密度结节,未治疗,两周后症状缓解。入院前3个月奔跑追赶机动车后出现咳嗽、咳白黏痰、胸痛,咯暗红色血痰。体检未发现异常。白细胞计数正常,嗜酸性粒细胞百分比42.61%,胸部CT示右上肺结节3.4 cm×3.3 cm,较前增大。双肺多发斑片影,以右肺上叶及左肺下叶为重,病变沿支气管血管束分布。入院后行CT引导下经皮肺穿刺,穿刺标本细菌、真菌及抗酸染色均阴性,HE染色可见纤维板层样的囊壁,壁内多发细粒棘球绦虫头节,囊壁外侧为纤维素样坏死和嗜酸性粒细胞浸润,诊断肺包虫病,建议抗包虫治疗,患者因无自觉症状,未服药物。已随访5年,复查CT肺内团块影缩小。A 47-year-old man was referred to the pulmonary clinic with a 2-year history of productive cough and 3-month history of hemoptysis.Two years ago,his chest CT scan revealed a 2 cm×2 cm welldefined nodule in the right upper lung.His cough was alleviated without treatment.Three months ago,he had a productive cough with the bloody sputum after a running to catch the bus.Physical examination was normal.Complete blood count(CBC)showed an elevated eosinophil count(42.61%).Chest CT scan showed that the enlargement of the right upper lobe nodule(3.4 cm×3.3 cm),with bilateral pathy lesions distributed in the right upper lobe and the left lower lobe.Pathological study of needle specimen biopsy showed the lamellated cyst wall of hydatid cyst,brood capsule formation and hooklet.Pulmonary hydatidosis was diagnosed.It was recommended that the patient should be treated by surgery combined with albendazole.His symptoms relieved and lung nodules were shrinking without treatment after 5 years follow-up.

关 键 词：右上肺 右肺上叶 肺部阴影 抗酸染色 肺包虫病 细粒棘球绦虫 胸痛 白痰 

分 类 号：R563[医药卫生—呼吸系统]