Yoshimoto Akihiro, Ichikawa Yukari, Waseda Yuko, Yasui Masahide, Fujimura Masaki, Hebisawa Akira, Nakao Shinji
Department of Haematology-Oncology and Respiratory Medicine, Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa 920-8641.
Intern Med. 2004 Oct;43(10):982-5. doi: 10.2169/internalmedicine.43.982.
A 57-year-old man consulted our hospital with a history of the gradual onset of dyspnea and a productive cough. Chest computed tomographic (CT) scans showed a nodular shadow in a cavity lesion, and reticulonodular, cystic, and ground-grass opacities in the bilateral lung fields with honeycombing. He was diagnosed as having pulmonary aspergilloma and idiopathic pulmonary fibrosis (IPF). As an outpatient, he suffered from dyspnea upon physical exertion with exacerbation of the high-resolution CT (HRCT) opacities. An inhalation provocation test for Aspergillosis fumigatus was positive and chronic hypersensitivity pneumonitis (CHP) caused by Aspergillus was finally diagnosed. Insidious CHP is sometimes misdiagnosed as IPF. The diagnosis of insidious CHP should be made on the basis of a detailed history, specific HRCT findings, and lymphocyte-dominant bronchoalveolar lavage fluid cell findings.
一名57岁男性因逐渐出现呼吸困难和咳痰前来我院就诊。胸部计算机断层扫描（CT）显示空洞性病变内有结节状阴影，双肺野有网状结节、囊性和磨玻璃样混浊，并伴有蜂窝状改变。他被诊断为肺曲菌球和特发性肺纤维化（IPF）。作为门诊患者，他在体力活动时出现呼吸困难，高分辨率CT（HRCT）混浊加重。烟曲霉吸入激发试验呈阳性，最终诊断为由曲霉菌引起的慢性过敏性肺炎（CHP）。隐匿性CHP有时会被误诊为IPF。隐匿性CHP的诊断应基于详细的病史、特定的HRCT表现以及以淋巴细胞为主的支气管肺泡灌洗液体细胞表现。
