Gera Kamal, Panjabi Chandramani, Dash Devijyoti, Shah Ashok
Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.
Department of Respiratory Medicine, Mata Chanan Devi Hospital, Delhi, India.
BMJ Case Rep. 2014 Oct 17;2014:bcr2014206280. doi: 10.1136/bcr-2014-206280.
Cavitation in pulmonary sarcoidosis is rather unusual and even rarer in the alveolar form of the disease. A review of the literature revealed only 13 documented patients with cavitating alveolar sarcoidosis. Of the 13 patients, clinical information was available in only eight cases. Aspergilloma complicating cavitary alveolar sarcoidosis has been documented only once before. A 38-year-old woman with progressive dyspnoea for 3 years presented owing to a bout of haemoptysis. Imaging prior to presentation demonstrated mediastinal lymphadenopathy and coalescent parenchymal alveolar opacities along with air bronchograms, suggestive of alveolar sarcoidosis. On presentation, cavitations were visible in both lungs within the consolidation along with an intracavitary mass in the left upper lobe, which on evaluation was recognised as an aspergilloma. Bronchoscopy disclosed non-caseating granulomas on histopathology confirming pulmonary sarcoidosis. Cavitary alveolar sarcoidosis with aspergilloma formation can result in a diagnostic dilemma, especially in endemic tuberculous areas.
肺结节病中的空洞形成相当罕见，在肺泡型疾病中更为罕见。文献回顾显示，仅有13例有记录的肺泡型结节病合并空洞形成的患者。在这13例患者中，仅8例有临床资料。曲霉球合并空洞型肺泡结节病此前仅有一次记录。一名38岁女性，因咯血就诊，有3年进行性呼吸困难病史。就诊前的影像学检查显示纵隔淋巴结肿大、融合的实质肺泡性混浊及空气支气管征，提示肺泡结节病。就诊时，两肺实变区内可见空洞，左上叶有空洞内肿块，经评估为曲霉球。支气管镜检查组织病理学显示非干酪样肉芽肿，确诊为肺结节病。空洞型肺泡结节病合并曲霉球形成可导致诊断困境，尤其是在结核病流行地区。
