Iwasaki Takeo, Mori Masahide, Kitada Seigo, Fushitani Kenji, Motone Masaharu, Namba Yoshinobu, Yosimura Kenji, Niinaka Manabu, Miki Mari, Miki Keisuke, Naka Nobuyuki, Hiraga Toru, Ito Masami, Yokota Soichiro, Maekura Ryoji
Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital.
Nihon Kokyuki Gakkai Zasshi. 2007 Jan;45(1):59-64.
On routine physical checkup, a 27-year-old man with productive cough was found to have multiple nodules with cavitation in the bilateral lung fields and mediastinal and hilar lymph adenopathy on chest X-ray film and CT scan. Serum levels of angiotensin converting enzyme and lysozyme were high. Tuberculin reaction was negative. Non-caseous epitheloid granulomas were confirmed in the bronchial wall specimens obtained by trans-bronchial biopsy. The number of lymphocytes and the CD4/CD8 ratio of lymphocytes in bronchoalveolar lavage fluid was increased. Therefore, pulmonary sarcoidosis was diagnosed, and the lung nodules with cavitation were considered due to sarcoidosis. The walls of the cavitations gradually thinned and had almost completely vanished after 6 months of careful observation without steroid therapy.
在常规体检中,一名27岁有咳痰的男子在胸部X光片和CT扫描中被发现双侧肺野有多个伴有空洞的结节以及纵隔和肺门淋巴结肿大。血清血管紧张素转换酶和溶菌酶水平升高。结核菌素反应为阴性。经支气管活检获得的支气管壁标本中证实有非干酪样上皮样肉芽肿。支气管肺泡灌洗液中淋巴细胞数量及淋巴细胞CD4/CD8比值升高。因此,诊断为肺结节病,伴有空洞的肺结节被认为是结节病所致。在未进行类固醇治疗的情况下仔细观察6个月后,空洞壁逐渐变薄并几乎完全消失。