患者女,61岁,右肺腺癌伴右肺门、纵隔、右锁骨上淋巴结转移及多发骨转移3年余,接受程序性死亡蛋白1(programmed death protein 1,PD-1)抑制剂治疗5个月后出现气短,进行性加重,无发热、咳嗽、咳痰。查体:双肺呼吸音粗,双下肺可闻及velcr...患者女,61岁,右肺腺癌伴右肺门、纵隔、右锁骨上淋巴结转移及多发骨转移3年余,接受程序性死亡蛋白1(programmed death protein 1,PD-1)抑制剂治疗5个月后出现气短,进行性加重,无发热、咳嗽、咳痰。查体:双肺呼吸音粗,双下肺可闻及velcro啰音。实验室检查:白细胞计数12.5×10^9/L,中性粒细胞73.4%。CT:双肺弥漫性分布实变影及磨玻璃影,伴支气管扩张,以双肺下叶基底段及胸膜下为著(图1A),提示双肺炎症,病因待查?行纤维支气管镜检查。病理:光镜下见局部肺泡间隔断裂,少量肺泡内纤维结节形成,肺泡上皮细胞增生、肺间质增厚及多种炎症细胞浸润,未见肿瘤细胞(图1B)。病理诊断:免疫检查点抑制剂相关肺炎(checkpoint inhibitor-related pneumonitis,CIP)。立即停止免疫治疗,予泼尼松治疗3周,复查CT显示双肺病变部分吸收,仍见多发磨玻璃影及实变影,伴支气管扩张(图1C)。予减量泼尼松连续治疗3个月,复查CT:双肺磨玻璃影、实变较前明显增多(图1D)。继续治疗1周,症状改善,患者出院并接受定期复查。展开更多
Background Legionella is an important community-acquired pneumonia pathogen.Although the elderly are especially susceptible to Legionella,few studies have looked at comparative radiographic features of Legionella pneu...Background Legionella is an important community-acquired pneumonia pathogen.Although the elderly are especially susceptible to Legionella,few studies have looked at comparative radiographic features of Legionella pneumonia in this population.The aim of this study was to explore the chest radiographic characteristics of community-acquired Legionella pneumonia in the elderly.Methods Serial chest radiographs obtained in 34 patients hospitalized with serologically proven Legionella pneumonia were retrospectively reviewed.Chest x-ray features of an aged group of ≥65 years were assessed and compared with a non-aged group of ＜65 years old with regard to initial patterns and distributions of pulmonary abnormalities,accompanying signs,and progression.Results The most common initial presentation was a patchy alveolar infiltrate involving a single lobe,most often the lower lobe.There was no middle or lingular lobe involvement in the aged group patients,but bilateral pleural effusion was significantly more common in this group.In the aged group patients,radiographic progression following adequate therapy,despite a clinical response,was more often noted and the radiographs were less likely to have returned to the premorbid state at discharge,but the differences were not significant between the two groups.Conclusion The discrepancy between imaging findings and clinical symptoms seems more prominent in community-acquired Legionella pneumonia in the elderly.展开更多
文摘患者女,61岁,右肺腺癌伴右肺门、纵隔、右锁骨上淋巴结转移及多发骨转移3年余,接受程序性死亡蛋白1(programmed death protein 1,PD-1)抑制剂治疗5个月后出现气短,进行性加重,无发热、咳嗽、咳痰。查体:双肺呼吸音粗,双下肺可闻及velcro啰音。实验室检查:白细胞计数12.5×10^9/L,中性粒细胞73.4%。CT:双肺弥漫性分布实变影及磨玻璃影,伴支气管扩张,以双肺下叶基底段及胸膜下为著(图1A),提示双肺炎症,病因待查?行纤维支气管镜检查。病理:光镜下见局部肺泡间隔断裂,少量肺泡内纤维结节形成,肺泡上皮细胞增生、肺间质增厚及多种炎症细胞浸润,未见肿瘤细胞(图1B)。病理诊断:免疫检查点抑制剂相关肺炎(checkpoint inhibitor-related pneumonitis,CIP)。立即停止免疫治疗,予泼尼松治疗3周,复查CT显示双肺病变部分吸收,仍见多发磨玻璃影及实变影,伴支气管扩张(图1C)。予减量泼尼松连续治疗3个月,复查CT:双肺磨玻璃影、实变较前明显增多(图1D)。继续治疗1周,症状改善,患者出院并接受定期复查。
文摘Background Legionella is an important community-acquired pneumonia pathogen.Although the elderly are especially susceptible to Legionella,few studies have looked at comparative radiographic features of Legionella pneumonia in this population.The aim of this study was to explore the chest radiographic characteristics of community-acquired Legionella pneumonia in the elderly.Methods Serial chest radiographs obtained in 34 patients hospitalized with serologically proven Legionella pneumonia were retrospectively reviewed.Chest x-ray features of an aged group of ≥65 years were assessed and compared with a non-aged group of ＜65 years old with regard to initial patterns and distributions of pulmonary abnormalities,accompanying signs,and progression.Results The most common initial presentation was a patchy alveolar infiltrate involving a single lobe,most often the lower lobe.There was no middle or lingular lobe involvement in the aged group patients,but bilateral pleural effusion was significantly more common in this group.In the aged group patients,radiographic progression following adequate therapy,despite a clinical response,was more often noted and the radiographs were less likely to have returned to the premorbid state at discharge,but the differences were not significant between the two groups.Conclusion The discrepancy between imaging findings and clinical symptoms seems more prominent in community-acquired Legionella pneumonia in the elderly.
