Yokomura K, Yasuda K, Sato M, Chida K, Nakamura H
Department of Respiratory Medicine, Iwata Municipal General Hospital.
Kansenshogaku Zasshi. 1998 Apr;72(4):410-3. doi: 10.11150/kansenshogakuzasshi1970.72.410.
A 56-year-old male without respiratory symptoms, past history nor familial history, was admitted to our hospital because of pulmonary solitary nodule on the chest radiograph. Computed tomograph showed a smooth surface nodule in the left lower lobe (segment 8). Bronchofiberscopy could not give any specific histological findings nor bacteriological findings, therefore the patient underwent partial pulmonary resection by videoassisted thoracoscopic surgery. Pathology of the resected specimen revealed epithelioid cell granuloma with giant cells but not any acid-fast bacilli. He was treated with rifampicin and isoniazid for "tuberculoma". After three weeks, thirty colonies grew on an Ogawa's egg medium, which were identified as Mycobacterium avium by PCR. There are few reports about the solitary pulmonary nodule due to M. avium-intracellurale complex infection, however, it is supposed that there are many "tuberculoma's" without bacteriological differentiation between tuberculosis and nontuberculous mycobacterial infection. It is difficult to diagnose a solitary pulmonary nodule caused by nontuberculous mycobacterial infection with bronchofiberscopy, and the location of the lesion is usually subpleural, therefore it is thought that videoassisted thoracoscopic surgery is valied for the diagnosis of solitary pulmonary nodule due to nontuberculous mycobacterium.
一名56岁男性，无呼吸系统症状、既往史及家族史，因胸部X线片发现肺部孤立性结节入院。计算机断层扫描显示左肺下叶（8段）有一个表面光滑的结节。纤维支气管镜检查未发现任何特异性组织学及细菌学结果，因此该患者接受了电视辅助胸腔镜手术下的部分肺切除术。切除标本的病理显示为上皮样细胞肉芽肿伴巨细胞，但未发现抗酸杆菌。他接受了利福平和异烟肼治疗“结核瘤”。三周后，在小川氏鸡蛋培养基上长出30个菌落，经聚合酶链反应鉴定为鸟分枝杆菌。关于鸟分枝杆菌复合群感染导致孤立性肺结节的报道很少，然而，推测存在许多在结核病和非结核分枝杆菌感染之间未进行细菌学鉴别的“结核瘤”。通过纤维支气管镜检查很难诊断非结核分枝杆菌感染引起的孤立性肺结节，且病变位置通常在胸膜下，因此认为电视辅助胸腔镜手术对诊断非结核分枝杆菌引起的孤立性肺结节有效。
