Ramesh Venkat, Acharya Vishak, Pai Narasimha, Krishnan Ananda
Internal Medicine, Kasturba Medical College, Mangalore, Karnataka, India.
Kasturba Medical College, Manipal University, Mangalore, Karnataka, India.
BMJ Case Rep. 2015 Mar 2;2015:bcr2014206963. doi: 10.1136/bcr-2014-206963.
A 37-year-old man presented with a history of episodic wheeze and breathlessness of 3 years' duration refractory to treatment. Physical examination revealed diffuse expiratory polyphonic rhonchi while the remainder of the examination including the cardiac examination was reported as normal. Pulmonary function testing revealed mild obstruction with bronchodilator reversibility. The patient was discharged on a 6-month course of antitubercular treatment (ATT) as bronchial brush cytology (obtained via bronchoscopy) was positive for acid-fast bacilli. The patient presented after completing 6 months of ATT with persistent symptoms, a loud S1 and a mid-diastolic murmur at the apex. High-resolution CT of the chest showed bilateral dependent ground glass opacities. An echocardiogram revealed a left atrial myxoma, and normal RV size and pressures. The patient underwent successful surgical removal of the same, and made a complete recovery. Refractory wheeze is a very unusual presentation of a left atrial myxoma.
一名37岁男性，有发作性喘息和呼吸困难病史3年，治疗无效。体格检查发现弥漫性呼气性多音哮鸣音，而包括心脏检查在内的其余检查均报告正常。肺功能测试显示轻度阻塞且支气管扩张剂可逆。由于支气管刷检细胞学检查（通过支气管镜获得）抗酸杆菌呈阳性，该患者接受了为期6个月的抗结核治疗（ATT）。患者在完成6个月的ATT治疗后仍有持续症状，第一心音响亮，心尖部有舒张中期杂音。胸部高分辨率CT显示双侧坠积性磨玻璃影。超声心动图显示左心房黏液瘤，右心室大小和压力正常。该患者成功接受了手术切除，完全康复。难治性喘息是左心房黏液瘤非常罕见的表现。
