第109课nbsp病例分析002
女，53岁。全身乏力2个月余，近4天咳嗽，咳白痰，发热，体温38.5℃。抗感染治疗4天，效果不佳，无粉尘接触史。CT如下：
CT影像所见：两肺野见弥漫性分布、大小、密度均匀的粟粒样影，两下肺纹理显示欠清。纵膈窗见斑点状高密度影，纵膈淋巴结未见肿大，器官、支气管开口通畅。
CTimagingcansee:twolungdiffusedistribution,size,densityuniformityofmilletsample,bothlungstextureaccordingtoowe.Mediastinalwindowseepunctatehighdensityshadow,mediastinallymphnodenoswelling,organ,bronchialopeningunobstructed.
观点分析：
观点一：考虑急性血行播散性肺结核。主要表现：两肺野弥漫分布大小较一致，密度较一致，随机性分布的粟粒小结节影，边界清晰，为较典型急性血行播散性肺结核的CT表现。结合临床上急性起病、发热病史及抗感染治疗无效，应该首先考虑本病的可能。本病主要应与肺泡蛋白沉积症，弥漫性细支气管肺泡癌、肺泡微石症、肺尘埃沉着症等疾病鉴别，结合本病较典型‘三均匀’的CT表现及急性起病，抗感染治疗无效的特点，应该首先考虑急性血行播散性肺结核。
Idea1:consideracutedisseminatedtuberculosisbloodline.Mainperformance:twolungdiffusedistributionofsizeisconsistent,densityisconsistent,therandomdistributionofmilletnodules,theboundaryisclear,isamoretypicalacuteCTmanifestationofdisseminatedtuberculosisbloodline.Combinedwiththeclinicalhistoryofacuteonset,feverandanti-infectiontreatmentisinvalid,shouldfirstconsiderthepossibilityofthisdisease.Thediseaseshouldbemainlyandalveolarproteindepositiondisease,diffusebronchioloalveolarcarcinomaandalveolarmicrostonedisease,suchaspneumoconiosisdiseasediseaseidentification,医院可以治疗白癜风北京看白癜风医院哪家比较好
