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患者男,57岁。咳嗽、气喘1个月,咯血伴呼吸困难5 d。1个月前无明显诱因出现咳嗽,咳白色痰,伴活动后气喘,口服头孢类药物无效。5 d前突发咯血,伴呼吸困难。既往有左肾透明细胞癌手术史2年,肝硬化病史3年。查体:气管左偏,左肺叩诊呈实音,呼吸音消失。实验室检查:血、尿、大便常规、凝血功能、肝肾功能均正常。颅脑CT未见异常。胸部CT示:左主支气管腔内及周围见软组织影,肺下叶见阻塞性肺炎,无肺不张(图1)。正电子发射计算机断层显像(PET-CT)示:左肺门主支气管旁高代谢病变伴局部气管狭窄,考虑肿瘤
Male patient, 57 years old. Cough, asthma for 1 month, hemoptysis with dyspnea 5 d. 1 month ago no obvious incentive to cough, cough white sputum, asthma with activity, oral cephalosporins invalid. Sudden hemoptysis 5 d with respiratory difficulties. Past history of left renal clear cell carcinoma surgery 2 years, history of cirrhosis 3 years. Physical examination: left trachea, left lung percussion was solid tone, breath sounds disappear. Laboratory tests: blood, urine, stool routine, coagulation, liver and kidney function are normal. No abnormal brain CT. Chest CT showed: the left main bronchus and soft tissue around the cavity, obstruction of the lower lobe pneumonia, no atelectasis (Figure 1). Positron emission tomography (PET-CT) shows: Left hilar bronchial hypermetabolic lesions with local tracheal stenosis, consider the tumor