Aigner K, Bolitschek J, Würtz J
Pneumologischen Abteilung, Krankenhauses der Elisabethinen, Linz.
Acta Med Austriaca. 1994;21(4):95-9.
Diagnosing of alveolitis is a puzzle of many pieces, based on clinical experience and keeping in mind the criteria of extrinsic allergic alveolitis. They are antigen-exposure, typical delayed postexpositional symptoms (cough, chills, fever, dyspnea, tiredness), and serological tests of precipitating antibodies. Helpful findings are X-ray of the chest, high resolution computer tomography, auscultation findings, lowered diffusing capacity, bronchoalveolar lavage with lymphocytes > 50% and low T4/T8-ratio, histology of periphere lung specimens, and occasional inhaled provocation. Differential diagnosis are toxic lung disorders, drug adverse effects, sarcoidosis, silicosis, autoimmune alveolitis, idiopathic fibrosing alveolitis. The most frequent failure in diagnosis are common viral cold, bronchopneumonia, sarcoidosis, chronic bronchitis, and miliar tuberculosis.
基于临床经验并牢记外源性过敏性肺泡炎的标准，肺泡炎的诊断是一个由多个部分组成的难题。这些标准包括抗原暴露、典型的暴露后延迟症状（咳嗽、寒战、发热、呼吸困难、疲倦）以及沉淀抗体的血清学检测。有用的检查结果包括胸部X线、高分辨率计算机断层扫描、听诊结果、弥散功能降低、淋巴细胞>50%且T4/T8比值低的支气管肺泡灌洗、外周肺标本的组织学检查以及偶尔的吸入激发试验。鉴别诊断包括中毒性肺疾病、药物不良反应、结节病、矽肺、自身免疫性肺泡炎、特发性肺纤维化。诊断中最常见的失误是普通病毒性感冒、支气管肺炎、结节病、慢性支气管炎和粟粒性肺结核。
