Fujishita M, Kataoka R, Kobayashi M, Miyoshi I
Department of Third Internal Medicine, Kochi Medical School, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1990 Jul;28(7):1018-23.
A 49-year-old woman visited our hospital for further examination of abnormal lung shadows in September 1984. She had suffered from pneumonia at the age of 3 years and had been treated for bronchial asthma until the age of 15. Many thin-wall cystic shadows were seen on her chest X-ray film in 1983. In July 1984, a mass-like lesion with a meniscus sign appeared in one of the cystic shadows. The number and the size of similar lesions increased with worsening of productive cough. An infiltrative shadow was recognized in the left lower lobe in September 1987 and January 1988, but was resolved by treatment by ofloxacin. Frequent bacterial examinations of sputum and bronchial secretions revealed numerous Pseudomonas aeruginosa but no fungi. Serum antibody to Aspergillus fumigatus was negative and antifungal therapy was not effective. Bronchography showed many cystic dilated bronchi, which ballooned during inspiration and collapsed with expiration. The peripheral bronchi seemed to be normal. These findings along with her clinical course led us to make a diagnosis of Williams-Campbell syndrome. The mass-like shadows were considered to have arisen from viscid secretions that were rendered round by the characteristic movement of the ectatic bronchi.
1984年9月，一名49岁女性因肺部阴影异常来我院进一步检查。她3岁时患过肺炎，15岁前一直在接受支气管哮喘治疗。1983年，她的胸部X光片上出现了许多薄壁囊性阴影。1984年7月，其中一个囊性阴影中出现了一个有半月板征的肿块样病变。随着咳痰加重，类似病变的数量和大小增加。1987年9月和1988年1月，左下叶出现浸润性阴影，但经氧氟沙星治疗后消散。对痰液和支气管分泌物进行的多次细菌检查发现大量铜绿假单胞菌，但未发现真菌。烟曲霉血清抗体阴性，抗真菌治疗无效。支气管造影显示许多囊性扩张的支气管，吸气时膨胀，呼气时塌陷。外周支气管似乎正常。这些发现以及她的临床病程使我们诊断为威廉姆斯-坎贝尔综合征。肿块样阴影被认为是由黏稠分泌物形成的，这些分泌物因扩张支气管的特征性运动而呈圆形。
