Zaw Kyi Kyi, Wasgewatta Sanjiwika L, Kwong Kin Keung, Fielding David, Heraganahally Subash S, Currie Bart J
Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, NT, Australia.
Department of Respiratory Medicine, Royal Brisbane Hospital, Brisbane, Queensland, Australia.
Respir Med Case Rep. 2019 Jun 29;28:100894. doi: 10.1016/j.rmcr.2019.100894. eCollection 2019.
Diagnosis of pulmonary mass lesions can be challenging with several possible differentials. A 41-year-old Caucasian woman presented with intermittent non-specific chest pain on a background of 30 pack years of smoking history. A CT scan of the chest confirmed an opacity in the right lower lobe suspicious for primary pulmonary malignancy and PET scan showed moderate FDG avidity of the lesion. Conventional flexible bronchoscopy did not demonstrate an endobronchial lesion, Using Endobrochial Ultrasound (EBUS) Guide sheath technique, the lesion was localized in the posterior segment of the right lower lobe. Brushings, biopsies and washings were taken through the guide sheath, along with transbronchial cryobiopsy. Culture of bronchial brushings from the lesion on Ashdown's agar medium showed , confirming melioidosis. Treatment was with intravenous ceftazidime for 4 weeks, followed by oral sulphamethoxazole/trimethoprim for 3 months. During the follow up visits, the patient demonstrated significant improvement both clinically and radiologically.
肺部肿块病变的诊断具有挑战性，存在多种可能的鉴别诊断。一名41岁的白人女性，有30年的吸烟史，出现间歇性非特异性胸痛。胸部CT扫描证实右下叶有一不透明区，怀疑为原发性肺恶性肿瘤，PET扫描显示该病变有中等程度的FDG摄取。传统的可弯曲支气管镜检查未发现支气管内病变，采用支气管内超声（EBUS）引导鞘技术，将病变定位在右下叶后段。通过引导鞘进行刷检、活检和灌洗，并进行经支气管冷冻活检。病变支气管刷检物在阿什当琼脂培养基上培养显示……，确诊为类鼻疽。治疗采用静脉注射头孢他啶4周，随后口服复方磺胺甲恶唑3个月。在随访期间，患者在临床和影像学上均有显著改善。
