Yatera Kazuhiro, Izumi Miiru, Imai Makoto, Ikegami Tomomi, Miyazaki Naoki, Kido Masamitsu
Division of Respiratory Disease, Nippon Steel Yawata Memorial Hospital, University of Occupational and Environmental Health, Yahata-Nishiku, Kitakyushu City, Fukuoka, Japan.
Nihon Kokyuki Gakkai Zasshi. 2003 Dec;41(12):894-8.
A 22-year-old woman was referred to our hospital suffering from repeated exacerbation of infiltrates confined to the medial portion of the right lower lung lobe, suggestive of pulmonary sequestration. Angiography revealed an anomalous vessel originating from the left side of the descending aorta, flowing behind it into the right lower lobe, the blood being returned to the pulmonary veins. A resection of the right lower lobe was conducted via thoracotomy. However, since there was no clear normal lung-pleura interface, this was classified as Pryce II type intralobar sequestration. Epithelioid granulomas with associated caseation necrosis confined to the sequestrated lung were confirmed by a polymerase chain reaction as Mycobacterium tuberculosis. Following oral antituberculosis drug administration, the patient recovered uneventfully. Superimposition of tuberculosis confined to a sequestrated lung portion is extremely rare. The presence of the aberrant artery led us to conclude that the intralobar sequestration must have been congenital.
一名22岁女性因右下肺叶内侧反复出现浸润灶并提示肺隔离症而转诊至我院。血管造影显示一条异常血管发自降主动脉左侧,在其后方流入右下叶,血液回流至肺静脉。通过开胸手术切除右下叶。然而,由于没有清晰的正常肺 - 胸膜界面,故将其归类为普赖斯II型叶内型肺隔离症。通过聚合酶链反应证实,局限于隔离肺内的上皮样肉芽肿伴干酪样坏死为结核分枝杆菌所致。口服抗结核药物治疗后,患者顺利康复。局限于隔离肺部分的肺结核叠加极为罕见。异常动脉的存在使我们得出结论,叶内型肺隔离症必定是先天性的。