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病例:男,5岁。于1989年5月22日住院。2个月前始间断发热,体温最高39℃,阵发性咳嗽,有少量白粘痰,咳时左侧胸痛,无咯血。多家医院胸部X线检查均提示“肺部肿瘤,左上肺结核不除外”。病后无盗汗及体重下降。无结核病接触史。查体:体温37.5,脉搏110,呼吸30,体重16公斤。颈部、锁骨上及腹股沟可触及数个肿大的淋巴结,最大如蚕豆,活动,无触痛。气管居中,左上肺呼吸音减弱,可闻少量痰鸣,心无异常。腹平坦,肝肋下4cm,剑突下5cm,脾肋下2cm,质软。WBC 15.d×10~9/L。N 0.60,L 0.30,M 0.08,E 0.02,Hb 135g/L,RBC4.4×10~(12)=/L。血沉40mm/1h。X线检查:左肺上野可见一球形阴影,密度较高,边缘较清,与纵隔相连。3次痰涂片均未找到抗酸杆菌;3次痰培养,2次阴性,1次有肺
Case: male, 5 years old. May 22, 1989 hospitalization. Intermittent fever 2 months ago, the highest temperature 39 ℃, paroxysmal cough, a small amount of white sticky sputum, cough left chest pain, no hemoptysis. A number of hospital chest X-ray examination showed that “lung cancer, upper left pulmonary tuberculosis is not excluded.” After the disease no night sweats and weight loss. No history of TB exposure. Physical examination: body temperature 37.5, pulse 110, breathing 30, weight 16 kg. Neck, supraclavicular and groin can reach several swollen lymph nodes, such as broad beans, activity, no tenderness. Central trachea, left lung breath sounds weakened, can smell a small amount of phlegm, no abnormal heart. Abdomen flat, liver ribs 4cm, xiphoid 5cm, spleen ribs 2cm, soft. WBC 15.d × 10 ~ 9 / L. N 0.60, L 0.30, M 0.08, E 0.02, Hb 135 g / L, RBC 4.4 × 10 12 = / L. ESR 40mm / 1h. X-ray examination: the left lung Ueno can be seen a spherical shadow, higher density, clearer margin, and the mediastinum connected. 3 sputum smear did not find acid-fast bacilli; 3 sputum culture, 2 negative, 1 lung