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患者女,13岁。因肺内粟粒样病变而就诊。近五年来颈部肿块逐渐增大,且有胸痛、咳嗽、咯白色泡沫痰、偶带血丝、活动后气短。1973年在当地医院诊断为结节性甲状腺肿Ⅰ°,行手术治疗。术前透视发现肺内有点状阴影,摄片后诊断为粟粒型肺结核,抗痨治疗二年余未见好转。1974、1976年又两次来诊,结果同前,1978年4月再次就诊。检查:无突眼和色素沉着,在右颈部可扪及肿大的甲状腺和淋巴结,质硬,腺体表面凸凹不平,压痛(+),与周围组织粘连。心率正常,肺部可闻及粗糙的呼吸音,肝脾未及。化验:白细胞10900,血沉10毫米以上/每小时,痰涂片未查到抗酸杆菌、霉菌和心力衰竭细胞,甲状腺扫描为右叶“冷结节”(图1),再次摄胸片为:双肺野
The patient is 13 years old. Treated with miliary lesions in the lungs. In the past five years, the neck mass has gradually increased, with chest pain, cough, slightly white foam, occasional bloodshot, and shortness of breath after exercise. In 1973, diagnosed as a nodular goiter at the local hospital, surgical treatment was performed. Preoperative fluoroscopy revealed a kind of shadow in the lungs. After the radiography, miliary tuberculosis was diagnosed. There was no improvement in antituberculosis treatment for more than two years. In 1974 and 1976, he visited the hospital twice. The results were the same as before. In April 1978, he returned to the clinic. Examination: No exophthalmos and hyperpigmentation, thyroid glands and lymph nodes in the right neck can be enlarged and hard, the surface of the gland is uneven, tender (+), and adheres to surrounding tissues. Normal heart rate, lungs can smell rough breath sounds, liver and spleen is not. Laboratory tests: Leukocytes 10900, ESR above 10 mm/h, sputum smear did not find acid-fast bacilli, mold, and heart failure cells, and the thyroid scan was a “cold nodule” on the right lobe (Figure 1). Again, the chest radiograph was: Double lung fields