Kurasawa T, Ikeda T, Inoue T, Nakatani K, Sato A, Ikeda N, Ichinose M, Inoue S, Takahashi K
Respiratory Medicine and Thoracic Surgery, National Minami-Kyoto Hospital, Joyo City, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1997 Feb;35(2):215-9.
A 71-year-old man was admitted to our hospital for evaluation of a solitary pulmonary nodule in the left lower lung field. He had been treated for Parkinson's disease for two years, and had no respiratory symptoms on admission. No abnormal findings were detected in laboratory tests on admission, and Mantoux's skin test was negative. A postero-anterior chest roentgenogram, a conventional tomogram, and a computed tomogram showed that the nodule was located in the left anterior basal segment (S8). The nodule was not calcified, the contour was clear but irregular, and pleural indentation could be seen, so the nodule was strongly suspected to be a primary malignant lung tumor. Because two attempts at transbronchial lung biopsy and bronchial brushing and washing were of no diagnostic value, a thoracotomy was done. The lesion was found in the subpleural region of the left S8 with pleural indentation, and it was partially resected. The nodule was elastic, soft, and filled with suppurative fluid. Histopathologic examination of the nodule revealed epithelioid cell granuloma. A smear test of the fluid was negative but a culture was positive for mycobacteria; which were identified as Mycobacterium kansasii. Rifampicin and isoniazid were administrated to the patient for 1 year. Two years after the operation, the patient was asymptomatic.
一名71岁男性因左下肺野孤立性肺结节入院评估。他患帕金森病已接受治疗两年，入院时无呼吸道症状。入院时实验室检查未发现异常，结核菌素皮肤试验阴性。后前位胸片、传统断层扫描和计算机断层扫描显示结节位于左前基底段（S8）。结节未钙化，轮廓清晰但不规则，可见胸膜凹陷，因此强烈怀疑该结节为原发性肺恶性肿瘤。由于两次经支气管肺活检及支气管刷检和灌洗均无诊断价值，遂行开胸手术。病变位于左S8胸膜下区域，有胸膜凹陷，部分切除。结节质地有弹性、柔软，充满脓性液体。结节的组织病理学检查显示上皮样细胞肉芽肿。液体涂片检查阴性，但培养结果显示分枝杆菌阳性；鉴定为堪萨斯分枝杆菌。患者接受利福平和异烟肼治疗1年。术后两年，患者无症状。
