五、最后诊断与诊断依据
最后诊断:
肺曲霉病
① 右上叶曲霉球
② 右肺尖半侵袭性肺曲霉病
③ 左上肺慢性炎症:曲霉感染可能
盆腔恶性肿瘤切除术后
高血压
诊断依据:
患者老年女性,慢性病程,主要表现为反复咳嗽、黄痰伴少量咯血,起病初表现为右肺上叶空洞性结节、左肺上叶斑片渗出影,予抗细菌治疗效果不佳,BALF曲霉抗原阳性,考虑右上肺曲霉球,伏立康唑治疗9月后右上肺病灶部分吸收,而左上肺病灶基本吸收。停药半年余后再次出现咯血,右上肺病灶较前增大,原病灶上方新增病灶,右肺尖TBLB病理:涂片见大量真菌菌丝(有隔,45°分枝);我院住院时TBLB病理:见曲霉菌菌团,伏立康唑联合卡泊芬净抗曲霉治疗,症状好转,未再咯血,随访胸部CT病灶基本吸收,故诊断。左上肺病灶影像学表现为渗出影,非典型曲霉感染病灶,虽无组织涂片或培养阳性依据及组织病理学依据,但考虑抗细菌治疗无效而抗曲霉治疗后明显吸收,故仍考虑曲霉感染的可能性大。
参考文献
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