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1 病例介绍 男,58岁。因低热、咳嗽、咳痰3个月,加重伴左胸痛10 d入院。体检:体温37.2℃、脉搏86次/min、呼吸22次/min、血压165/95 mmHg,消瘦体质,神志清,浅表淋巴结不大。双肺呼吸音粗,左肺底闻及少许湿罗音。心率88次/min,律齐,无杂音,无心包摩擦音。腹软,肝、脾未及。双侧杵状指,双下肢无水肿。辅助检查:血、尿常规及肝、肾功能均正常,血沉30 mm/h,IgG18.22 g/L,IgM.2.6 g/L。胸部X线示:双肺纹理增强,左肺上野中外侧带可见约3.8cm×3.2 cm团块状阴影,边缘较毛糙。胸部CT示:左肺上叶见软组织肿块影,大小约3.2 cm×2.8 cm,CT值约38 Hu,形态不规则,密度较均匀,其下方层面见不规则斑片状密度增强影,边缘不清,有毛刺。内侧与纵隔分界清晰。诊断
1 case description Male, 58 years old. Due to fever, cough, sputum for 3 months, aggravated with left chest pain 10 d admission. Physical examination: body temperature 37.2 ℃, pulse 86 beats / min, breathing 22 times / min, blood pressure 165/95 mmHg, weight-loss constitution, clear consciousness, superficial lymph nodes is not large. Breath sounds coarse lungs, the left lung smell and a little wet rales. Heart rate 88 beats / min, law Qi, no noise, no heart package friction sound. Abdominal soft, liver, spleen and time. Bilateral clubbing refers to both lower extremities without edema. Auxiliary examination: blood, urine and liver and kidney function were normal, erythrocyte sedimentation rate 30 mm / h, IgG18.22 g / L, IgM.2.6 g / L. Chest X-ray showed: double lung texture enhancement, the left lung Ueno can be seen in the medial and lateral bands of about 3.8cm × 3.2cm clumps, more rough edges. Chest CT showed: the left upper lobe see soft tissue mass, size of about 3.2 cm × 2.8 cm, CT value of about 38 Hu, irregular shape, the density is more uniform, the lower level to see irregular patchy density enhancement shadow, the edge is not Clear, burr. The medial and mediastinal boundaries are clear. diagnosis