Tran Tung, Melton Casey, Mughal Majid, Al-Ali Mohammad
Division of Pulmonary & Critical Care Medicine, University of South Alabama Medical Center, USA.
Conn Med. 2009 Jun-Jul;73(6):345-7.
A 48-year-old man with a 75-pack-year history of tobacco use was referred to pulmonary clinic for evaluation of an abnormal chest roentgenograph. He had been followed by his primary physician for bronchitis and nonproductive cough over the past year and was recently treated with a course of antibiotics with no change in symptoms. He had no other medical history, was currently smoking two packs of cigarettes per day, and reported working on the docks in a shipyard for five years. On physical examination, he was afebrile with stable vital signs and 97% oxygen saturation on room air. He was well-developed in no apparent distress. On cardiovascular examination, he was in sinus rhythm without murmurs. Chest examination was clear to auscultation. There was no lymphadenopathy. The abdomen was soft and benign. The extremities were without clubbing, cyanosis, or edema. The rest of the physical examination was unremarkable.
Laboratory data demonstrated a white blood cell count of 7,200/ul with a normal differential. Hemoglobin, platelet count, serum electrolytes, liver associated enzymes and coagulation studies were normal.
The patient had a chest computed tomography (CT) available for review (Fig. 2). What diagnostic study should be performed next?
一名有75年吸烟史（每天一包烟，共75年）的48岁男性因胸部X线片异常被转诊至肺部门诊。在过去一年里，他的初级保健医生一直对其进行支气管炎和干咳的随访，最近接受了一个疗程的抗生素治疗，但症状没有改善。他没有其他病史，目前每天吸两包烟，据报告曾在造船厂的码头工作五年。体格检查时，他体温正常，生命体征稳定，在室内空气中氧饱和度为97%。他发育良好，无明显痛苦。心血管检查显示为窦性心律，无杂音。胸部听诊清晰。无淋巴结病。腹部柔软，无异常。四肢无杵状指、发绀或水肿。其余体格检查无异常。
实验室检查数据显示白细胞计数为7200/ul，分类正常。血红蛋白、血小板计数、血清电解质、肝脏相关酶和凝血研究均正常。
患者有胸部计算机断层扫描（CT）可供查看（图2）。接下来应进行什么诊断性检查？
