一27岁男性因咯血入院。近6月来主诉厌食、疲乏及体重减轻达10公斤。两月来有间歇性发热及干咳。除此之外无特殊症状。过去史无特殊,不嗜烟酒,无结核病接触史,无异物进入呼吸道史。体格检查及一般血尿常规均无异常发现。痰涂片检查抗酸杆菌为阴性,但结核菌素试验呈强阳性反应。立位摄后前位及侧位胸片示右肺尖部双叶状(bilobe)阴影,余肺野及心影均基本正常(图1)。食道吞钡及胸椎摄片均正常。胸部 A 27-year-old man was hospitalized for hemoptysis. In the past 6 months, the main anorexia, fatigue and weight loss up to 10 kg. Two months have intermittent fever and dry cough. In addition there are no special symptoms. No past history, do not indulge tobacco and alcohol, no contact history of tuberculosis, no foreign body into the respiratory history. Physical examination and general hematuria no abnormal findings. Acid-fast bacilli were negative for sputum smear tests but strongly positive for tuberculin test. Standing position after radiography and lateral chest radiographs showed a bilobe shadow at the right apex of the lung and more than normal lung fields and heart images (Figure 1). Esophageal barium swallow and thoracic radiography are normal. chest