Kurasawa T, Ikeda N, Yamadori H, Sato A, Nakatani K, Takahashi K, Inoue S, Suzumura Y
Division of Respiratory Medicine, National Minami-Kyoto Hospital, Japan.
Kekkaku. 1994 Feb;69(2):83-7.
The report is a study of the cases in which elderly people (83 years-old male and 81 years-old female) diagnosed has having acute tuberculous pneumonia possibly suffered from subsequent perforation of lymph nodes in the bronchus. Neither of the patients had a prior history of tuberculosis treatment. Both patients were admitted to the hospital after being diagnosed with pneumonia. After the administration of antibiotics, the symptoms of illness improved, but chest roentgenograms were taken failed to show improvement. The patients were then transferred to our hospital, because sputa smear tests for Mycobacteria (Ziehl-Neelsen stain) were performed, and the results were positive. Case I (male) was suspected of having endobronchial tuberculosis, since rhonchi was audible in the left-front upper chest during expiration when performing auscultation. A bronchoscopy was conducted at which time ulcer lesions on the left upper lobe of the bronchus and perforated lymph node of the upper bronchus were detected. Case II (female) was suspected of having lung cancer and a bronchoscopy was performed due to the findings of a chest roentgenogram taken after one month of chemotherapy. A perforated lymph node in right truncus intermedius was detected. In this report, we discussed the early diagnosis of tuberculous pneumonia and the perforation of caseous lymph nodes in the bronchus, which was the main cause of tuberculous pneumonia.
该报告是一项关于病例的研究，其中两位老年人（83岁男性和81岁女性）被诊断患有急性结核性肺炎，可能随后出现支气管淋巴结穿孔。两位患者既往均无结核病治疗史。两位患者均在被诊断为肺炎后入院。使用抗生素后，病情症状有所改善，但胸部X光检查未见好转。随后患者被转至我院，因为进行了痰液分枝杆菌涂片检查（萋-尼氏染色），结果呈阳性。病例I（男性）被怀疑患有支气管内膜结核，因为听诊时在左上前胸部呼气时可闻及啰音。进行了支气管镜检查，此时在支气管左上叶发现溃疡病变及上叶支气管穿孔淋巴结。病例II（女性）被怀疑患有肺癌，在化疗一个月后进行胸部X光检查发现问题，遂进行了支气管镜检查。发现右中间支气管穿孔淋巴结。在本报告中，我们讨论了结核性肺炎的早期诊断以及支气管干酪样淋巴结穿孔，这是结核性肺炎的主要病因。
