To describe the clinical,radiological and pathological characteristics of idiopathic pulmonary alveolar proteinosis(I-PAP)and to evaluate the methods of diagnosis and treatment.Three patients were successfully diagnos...To describe the clinical,radiological and pathological characteristics of idiopathic pulmonary alveolar proteinosis(I-PAP)and to evaluate the methods of diagnosis and treatment.Three patients were successfully diagnosed and treated in our hospital and the literature on the subject was reviewed.Three patients,two males and one female(mean age 46 years),were diagnosed averagely in 4 months.Two severe patients presented with progressive dyspnea and type I respiratory failure,and one mild patient only with dry cough and hypoxemia.Chest X-ray radiographs all showed perihilar "butterfly" shadow and chest CT scans showed diffused ground-glass opacities(GGO),typically with "map" changes and "crazy paving" patterns.All the patients underwent bronchoscope,branchoalveolar lavage fluid(BALF)had grossly opaque and/or milky appearance and its sediment was periodic acid-Schiff stain positive.Transbronchoscopic lung biopsy(TBLB)specimens were obtained and under light microscopy alveoli and some of the small bronchioles were filled with eosinophilic proteinaceous material with needle-like clefts.By electron microscopy numerous cellular debris and extracellular multilamellated bodies were found.Two severe patients were successfully treated with sequential whole-lung lavage and one required repeated lavages.I-PAP is rare and prone to be misdiagnosed.The radiological features may indicate the diagnosis and examinations of TBLB and BALF can make the accurate diagnosis.Whole-lung lavage is the most effective therapy by now and granulocyte-macrophage colony-stimulating factor(GM-CSF)may be beneficial in some patients.展开更多
To investigate the clinical characteristics, diagnosis and therapy of influenza pneumonia with staphylococcal infection. One patient in our hospital was diagnosed and the literatures on the subject were reviewed. The ...To investigate the clinical characteristics, diagnosis and therapy of influenza pneumonia with staphylococcal infection. One patient in our hospital was diagnosed and the literatures on the subject were reviewed. The patient presented with high fever and dyspnea. Arterial gas analysis indicated type 1 respiratory failure. Chest X ray photographs showed bilateral infiltrations and bilatera encapsulated pleural effusions. Viral separation and culture of pharyngeal swab indicated H3N2 subtype of human influenza virus. Blood, sputum and bronchoalveolar lavage fluid (BALF) cultures showed Staphylococcus aureus. Pleural effusion was complex parapneumonic pleural effusion. After the administration of anti-virus, anti-staphylococcal antibiotics and pleural cavity drainage, the patient was cured. The infection of staphylococcus aureus is a typical characteristic of influenza pneumonia, and anti-staphylococcal antibiotic therapy (with MRSA activity in MRSA endemic regions) should be initiated in hospitalized cases of influenza pneumonia. If complex parapneumonic pleural effusion or empyema complicated, we should perform pleural cavity drainage in time. The oral neuraminidase inhibitor (oseltamivir) could significantly improve prognosis.展开更多
肺黏膜相关淋巴组织型边缘区B细胞淋巴瘤(marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue type,MALT-MZL)是一种较为罕见的肺部原发性恶性肿瘤。本例患者采用纤维支气管镜检查,经组织病理和免疫组化确诊,具...肺黏膜相关淋巴组织型边缘区B细胞淋巴瘤(marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue type,MALT-MZL)是一种较为罕见的肺部原发性恶性肿瘤。本例患者采用纤维支气管镜检查,经组织病理和免疫组化确诊,具有完整的病例资料,并结合国内相关资料进行文献分析,以探讨其临床、病理特点及诊断、治疗方法。患者主要表现为周期性发热、咳嗽、胸痛,用正规的抗生素治疗无效。胸部CT显示右肺中叶和左肺下叶实变,伴有支气管充气征和CT血管造影征,肺实变内可见扩张的支气管。左侧少量胸腔积液,是单核细胞为主的渗出液。血清蛋白电泳发现M蛋白。支气管镜下可见左肺下叶、右肺中叶支气管狭窄,用支气管镜进行透壁肺活检,病理为小淋巴细胞弥漫浸润,可见淋巴上皮病变;免疫组化CD20阳性,CD3,CD5,CD10,CD21,CD23,Bcl2和Bcl6阴性。肺MALT-MZL是肺原发性淋巴瘤中最常见的一种类型,大多数临床表现不典型,易误诊,及时行有创检查取得病理标本有助于早期诊断。某些临床表现(如周期性发热,肺实变及其内扩张的支气管,血浆或支气管肺泡灌洗液中出现M蛋白等)具有一定的特征性。治疗方法主要为手术、放疗和化疗。肺MALT-MZL属于惰性淋巴瘤,预后相对良好。展开更多
文摘To describe the clinical,radiological and pathological characteristics of idiopathic pulmonary alveolar proteinosis(I-PAP)and to evaluate the methods of diagnosis and treatment.Three patients were successfully diagnosed and treated in our hospital and the literature on the subject was reviewed.Three patients,two males and one female(mean age 46 years),were diagnosed averagely in 4 months.Two severe patients presented with progressive dyspnea and type I respiratory failure,and one mild patient only with dry cough and hypoxemia.Chest X-ray radiographs all showed perihilar "butterfly" shadow and chest CT scans showed diffused ground-glass opacities(GGO),typically with "map" changes and "crazy paving" patterns.All the patients underwent bronchoscope,branchoalveolar lavage fluid(BALF)had grossly opaque and/or milky appearance and its sediment was periodic acid-Schiff stain positive.Transbronchoscopic lung biopsy(TBLB)specimens were obtained and under light microscopy alveoli and some of the small bronchioles were filled with eosinophilic proteinaceous material with needle-like clefts.By electron microscopy numerous cellular debris and extracellular multilamellated bodies were found.Two severe patients were successfully treated with sequential whole-lung lavage and one required repeated lavages.I-PAP is rare and prone to be misdiagnosed.The radiological features may indicate the diagnosis and examinations of TBLB and BALF can make the accurate diagnosis.Whole-lung lavage is the most effective therapy by now and granulocyte-macrophage colony-stimulating factor(GM-CSF)may be beneficial in some patients.
文摘To investigate the clinical characteristics, diagnosis and therapy of influenza pneumonia with staphylococcal infection. One patient in our hospital was diagnosed and the literatures on the subject were reviewed. The patient presented with high fever and dyspnea. Arterial gas analysis indicated type 1 respiratory failure. Chest X ray photographs showed bilateral infiltrations and bilatera encapsulated pleural effusions. Viral separation and culture of pharyngeal swab indicated H3N2 subtype of human influenza virus. Blood, sputum and bronchoalveolar lavage fluid (BALF) cultures showed Staphylococcus aureus. Pleural effusion was complex parapneumonic pleural effusion. After the administration of anti-virus, anti-staphylococcal antibiotics and pleural cavity drainage, the patient was cured. The infection of staphylococcus aureus is a typical characteristic of influenza pneumonia, and anti-staphylococcal antibiotic therapy (with MRSA activity in MRSA endemic regions) should be initiated in hospitalized cases of influenza pneumonia. If complex parapneumonic pleural effusion or empyema complicated, we should perform pleural cavity drainage in time. The oral neuraminidase inhibitor (oseltamivir) could significantly improve prognosis.
文摘肺黏膜相关淋巴组织型边缘区B细胞淋巴瘤(marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue type,MALT-MZL)是一种较为罕见的肺部原发性恶性肿瘤。本例患者采用纤维支气管镜检查,经组织病理和免疫组化确诊,具有完整的病例资料,并结合国内相关资料进行文献分析,以探讨其临床、病理特点及诊断、治疗方法。患者主要表现为周期性发热、咳嗽、胸痛,用正规的抗生素治疗无效。胸部CT显示右肺中叶和左肺下叶实变,伴有支气管充气征和CT血管造影征,肺实变内可见扩张的支气管。左侧少量胸腔积液,是单核细胞为主的渗出液。血清蛋白电泳发现M蛋白。支气管镜下可见左肺下叶、右肺中叶支气管狭窄,用支气管镜进行透壁肺活检,病理为小淋巴细胞弥漫浸润,可见淋巴上皮病变;免疫组化CD20阳性,CD3,CD5,CD10,CD21,CD23,Bcl2和Bcl6阴性。肺MALT-MZL是肺原发性淋巴瘤中最常见的一种类型,大多数临床表现不典型,易误诊,及时行有创检查取得病理标本有助于早期诊断。某些临床表现(如周期性发热,肺实变及其内扩张的支气管,血浆或支气管肺泡灌洗液中出现M蛋白等)具有一定的特征性。治疗方法主要为手术、放疗和化疗。肺MALT-MZL属于惰性淋巴瘤,预后相对良好。
