Ding I, Bittmann I, Becker C, Behr J
Medizinische Klinik I des Klinikums Grosshadern, Munich.
Dtsch Med Wochenschr. 2003 Aug 15;128(33):1703-5. doi: 10.1055/s-2003-41336.
A 42-year-old woman was admitted because of a newly perceived pain localized in the ventral part of the fifth left rib. The physical examination was normal except for a palpable nodular thyroid and pain on palpation of this rib. The patient history contained a serious car accident and severe cigarette abuse.
The chest x-ray in "bone technique" showed an osteolysis in the fifth left rib, which was confirmed by computer tomography and bone scan. The high resolution CT scan of the lung revealed a discrete interstitial reticular pattern with minor cystic alterations without lymph node enlargement.
DIAGNOSIS, THERAPY AND CLINICAL COURSE: Transbronchial biopsy, bronchoalveolar lavage and a malignancy screening did not lead to a diagnosis. Therefore, the patient was submitted to partial rib resection and open lung biopsy. Histological examination revealed a Langerhans cell histiocytosis. The initial therapeutic approach was a strict smoking cessation.
The differential diagnosis of a lytic bone lesion in a heavy smoker should include Langerhans cell histiocytosis. On smoking cessation a remission of the disease may be achieved.
一名42岁女性因新发现的位于左第五肋腹侧的疼痛入院。体格检查除可触及的结节性甲状腺及该肋骨触诊疼痛外均正常。患者病史包括一起严重的车祸及严重的吸烟史。
“骨显像技术”胸部X线显示左第五肋有骨质溶解，计算机断层扫描和骨扫描证实了这一点。肺部高分辨率CT扫描显示有离散的间质网状模式，伴有轻微的囊性改变，无淋巴结肿大。
诊断、治疗及临床过程：经支气管活检、支气管肺泡灌洗及恶性肿瘤筛查均未得出诊断结果。因此，患者接受了部分肋骨切除及开胸肺活检。组织学检查显示为朗格汉斯细胞组织细胞增多症。最初的治疗方法是严格戒烟。
重度吸烟者溶骨性骨病变的鉴别诊断应包括朗格汉斯细胞组织细胞增多症。戒烟后疾病可能会缓解。
