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1 病例报告 1.1 例1 女,41岁,农民。自3年前起胸部不适,逐渐出现胸闷,伴轻咳,无痰,无发热及胸痛。起病后曾在当地医院就诊,经X线检查诊断为“大量结核性胸腔积液”,予以抗痨治疗及反复抽胸水,但胸水仍持续存在,以“结核性包裹性胸腔积液”收住我院。查体:T 36℃,P 94次/min,R 24次/min,BP 17/11kPa。一般情况好,表浅淋巴结不大。气管居中,颈静脉充盈,肝颈静脉回流征(+)。胸廓右侧第5前肋部位有局限性隆起,前胸自左第2肋,右第3肋以上叩实,呼吸音明显减低,背部叩清音,呼吸音正常。心界叩不出,心尖部心音遥远,剑下心音强,各瓣膜区无杂音,肝肋下1.5cm,剑突下2.5cm,脾未触及。下肢无浮肿。血白细胞7.8×10~9/L,N 0.74,L 0.24,M 0.02,血沉3mm/h。尿常规及肝功能正常。X线胸片:后前位示两肺野巨大球形密度增高影,边缘光滑,范围在左第6后肋、右第7后肋以下,左肋膈角在第6后肋以上,右肋膈角清晰,右上纵隔增宽,心影形态隐约可见,左肺门上方似一团块状阴影;侧位片示巨大囊状致密影,后缘与脊柱重叠,胸骨后间隙消失,诊断为包裹性胸腔积液。B超:前纵隔多房性囊性占位病变并胸腔包裹性积液。入院后在左腋前线第6、7肋间,左腋中线第7肋间,左腋后线第8肋间等不同部位反复抽液检查,结果不同,有的呈黄色混浊液体,蛋白(
1 case report 1.1 cases 1 female, 41 years old, farmer. Since 3 years ago from the chest discomfort, and gradually chest tightness, with light cough, no sputum, no fever and chest pain. After the onset of treatment in a local hospital, the X-ray examination diagnosed as “a large number of tuberculous pleural effusion”, anti-tuberculosis treatment and repeated pleural effusion, but pleural effusion persists to “tuberculous pleural effusion” income Live in our hospital. Examination: T 36 ℃, P 94 times / min, R 24 times / min, BP 17 / 11kPa. In general, the superficial lymph nodes are not large. Tracheal center, filling the jugular vein, hepatic jugular vein reflux sign (+). The fifth anterior rib cage on the right side of the thorax has limitations bulge, the chest from the left rib 2, right above the third rib tapping, significantly reduced breath sounds, the back knock voiceless, breath sounds normal. Heart knock knock, apex distant heart sounds, strong heart under the sword, the valve area without noise, liver ribs 1.5cm, xiphoid 2.5cm, spleen not touched. Lower extremity without edema. Blood leukocytes 7.8 × 10 ~ 9 / L, N 0.74, L 0.24, M 0.02, ESR 3mm / h. Urine and liver function is normal. X-ray: the posterior anterior showed a large spherical density of the two lung fields increased shadow, smooth edges, the scope of the left after the 6th rib, after the seventh under the rib, the left costal diaphragm angle in the sixth after the rib, the right rib Angle clear, the right upper mediastinum widened, diminished shape of the heart shadow, like a lump above the left hilum shadow; lateral film showed a huge cystic dense shadow, trailing edge and spine overlap, disappearance of the space after the sternum, the diagnosis of parcel Pleural effusion. B-ultrasound: anterior mediastinal multi-compartment cystic lesions and pleural enchancement. Admission in the left anterior axillary line 6,7 intercostal, left axillary midline 7th intercostal, left axillary line 8th intercostal and other parts of the repeated pumping test, different results, some were yellow turbid fluid, protein (