Shi L L, Zhen H T
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2018 Jun;32(12):953-955. doi: 10.13201/j.issn.1001-1781.2018.12.018.
A patient suffered from progressive dyspnea and even laryngeal obstruction visited our department in May, 2017 and received emergency tracheotomy for assistance in breathing. There was no dysphagia, sore throat, fever, cough, hemoptysis and hematuresis. The pathological signs including facies dolorosa, three depressions sign, perforation of nasal septum. The laboratory examination showed that there were hematuresis and albuminuria. The urine bilirubin levels were elevated, antineutrophil cytoplasmic antibody (ANCA) was positive and antiproteinase 3 antibody was elevated. The electronic laryngoscope revealed the swelling of infraglottic region and laryngeal CT showed the subglottic area occupation and stenosis. The pulmonary CT showed the irregular mass shadow in lower lobe of right lung which was considered benign pathological changes. Finally, the diagnosis was subglottic Wegner's granulomatosis and result in laryngeal obstruction and need the first aid in clinic.
一名患有进行性呼吸困难甚至喉梗阻的患者于2017年5月前来我科就诊，并接受了紧急气管切开术以辅助呼吸。患者无吞咽困难、咽痛、发热、咳嗽、咯血及血尿。病理体征包括面部疼痛、三凹征、鼻中隔穿孔。实验室检查显示有血尿和蛋白尿。尿胆红素水平升高，抗中性粒细胞胞浆抗体（ANCA）阳性且抗蛋白酶3抗体升高。电子喉镜显示声门下区肿胀，喉部CT显示声门下区占位及狭窄。肺部CT显示右肺下叶不规则肿块影，考虑为良性病变。最终诊断为声门下韦格纳肉芽肿病，导致喉梗阻，临床需急救。
