[医药卫生]chest

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1、SOLITARYPULMONARYNODULE1.A40-year-oldmalesmokerpresentswithahistoryofchroniccough.HehashadsymptomsofanupperrespiratoryillnessforafewmonthssincevisitingfamilyinArizona.Physicalexamisnormal.CXRisshownbelowinFig.1.Thenextstepinmanagementshouldbea.Completepulmonaryfunctiontestsb.Fiberopticbronchos

2、copyc.Percutaneousneedlebiopsyd.ObservationandrepeatCXRin6to8moFigure1.Thischestx-rayshowsaradiographicallydensenoduleinthelefthilum.Cardiophrenicandcostophrenicanglesareclear.An0.8×1-cmcircularsolitarypulmonarynodulewithperipheralyetdistinctcalcificationinthesuperioraspectisseenoverlyingthe5t

3、hposteriorribintherightupperlungzone.1.Theanswerisc.Basedontheageofthepatient,riskfactors,andpersistentsymptoms,furtherdiagnostictestsarewarranted.Observationfor6moisinappropriate.Duetotheperipheralnatureofthislesion,aCT-guidedneedlebiopsywouldbethebestdiagnosticstrategyandhaveabetteryieldthan

4、abronchoscopy.Pulmonaryfunctiontestswouldbehelpfulifsurgeryisplanned,butwouldnotalterthediagnosticsteps.Inthiscase,theCT-guidedbiopsyrevealedcoccidioidomycosis.Thisiscausedbyafungus(Coccidioidesimmitis)inthesoilandisseenindesertsemiaridclimateswithashort,intenserainyseason.Itisendemicinsouthwe

5、sternNorthAmerica,Mexico,andCentralandSouthAmerica.Mostpatientsareasymptomaticorrecoverfullyafterinitialflulikeillness.Theradiographicfindingsofcoccidioidomycosisarevariableanddependupontheseverityofthedisease.Mostgranulomasaresmallerthan2cm,andalmostallarelessthan3cminsize.BesidesSPNs,intheea

6、rlystagesofcoccidioidomycosispatchyinfiltratesmaybeaccompaniedbyhilarandmediastinaladenopathyandlessfrequentlybypleuraleffusion.Incasesofpersistentdisease,infiltratesmayenlarge.Items2–3A34-year-oldwoman,arecentimmigrantfromEasternEurope,isseenwithcomplaintsofvaguechestdiscomfortafteranupperres

7、piratorytractinfection.SheisnotasmokerandgivesahistoryofBCGvaccination卡介苗接种whenshewasaninfant.Physicalexaminationisnormal.PPDis10-mminduration硬结andinducedsputumforacid-fastbacilliisnegative.CXRisshowninFig.2.2.Whatisthemostlikelydiagnos