【双语病例】胸部原发后肺结核1例X线及CT影像表现

History: A 46-year-old woman presents with a positive Quantiferon-TB Gold test as part of a routine health screening for her new place of employment. She had previously worked for more than 20 years as a veterinary technician at a medical research laboratory. Over the course of her employment, she worked with rhesus monkeys actively infected with tuberculosis (TB).The patient is an active smoker with a 45-pack-year smoking history. She has multiple pets, including cats, dogs, and guinea pigs. The patient denied foreign travel or contact with individuals with known tuberculosis infection. She denies hemoptysis, but reports chills and night sweats of an unspecified length of time.

女性、46岁，在新工作体检中 Quantiferon-TB 金试验阳性。作为一名兽医技术员在医学研究实验室工作过20年。在工作的过程中，她曾让恒河猴感染了结核病（结核）。病人是一个积极的吸烟者，45包/年的吸烟史。她有多种宠物，包括猫、狗和豚鼠。患者否认外国旅行或与已知的结核病感染者接触。她否认咯血，但有过寒战和一个不明确多长时间的盗汗。

Chest radiographs are shown below.

【双语病例】胸部原发后肺结核1例X线及CT影像表现

Q1——What is the most relevant finding?

A Right upper lobe consolidation 右上叶肿块

B Perihilar adenopathy 肺门淋巴结肿大

C Blunting of the posterior costophrenic angles 后肋膈角变钝

D Apical lung scarring 肺尖瘢痕

E Peripheral atelectasis 外周肺不张

CT images are shown below. Click to enlarge. 【双语病例】胸部原发后肺结核1例X线及CT影像表现

【双语病例】胸部原发后肺结核1例X线及CT影像表现

Q2——Which of the following is the best description of the lesion in the right upper lobe?

A Apical granuloma 肺尖肉芽肿

B Cavitation, with thin walls and calcification 空洞，薄壁并钙化

C Cavitation, with thick and irregular walls 空洞，厚壁并不规则厚

D Large pleural-based nodule with spiculated margins 胸膜基底的大结节伴毛刺

Q3——There is evidence of an Aspergillus fungus ball formation.（霉菌球形成）

A True

B False

Q4——Lymphadenopathy 淋巴结肿大is the radiologic hallmark标志 of primary TB.

A True

B False

Q5——Due to the prolonged nature of the patient\’s exposure, respiratory isolation is not required pending culture.

A True

B False

Q6——Definitive diagnosis of active tuberculosis is based on which of the following?

A Acid-fast staining of sputum 痰抗酸染色

B Sputum culture 痰培养

C Polymerase chain reaction (PCR) of mycobacterial DNA 聚合酶链反应（PCR）对结核分枝杆菌DNA

D Blood culture 血培养

Q7——The patient should be offered HIV screening.

A True

B False

答案1-7：A C B A B B A

Findings and diagnosis

Findings

There is upper lobe apical segment heterogenous consolidation with cavitation. There is no lymphadenopathy.（上叶尖段含空洞的不均质实变，没有肿大淋巴结）

Differential diagnosis

Postprimary tuberculosis 原发后结核
Malignancy 恶性肿瘤
Sarcoidosis 结节病
Chronic fungal Infection 慢性真菌感染

Diagnosis

Postprimary tuberculosis【also called reactivation tuberculosis】

Discussion

Postprimary tuberculosis
Postprimary tuberculosis appears as upper lobe apical/posterior segment heterogenous consolidation with cavitation, with thick, nodular, and irregular walls. Cavitation is present in 45% of cases. Other findings include centrilobular nodules, tree-in-bud opacities, and acinar/lobular consolidations. Lymphadenopathy was not seen in this patient; however, it is present in 5% of cases.
Patients with impaired cellular immunity (such as those with HIV, in prisons, or who are homeless) have an increase susceptibility.
The most common signs/symtoms include cough, pleuritic chest pain, upper respiratory infection-type symptoms, and hemoptysis.
原发后结核表现为肺上叶尖段、后段的，不均质的含空洞的实变影，呈厚的、结节样、不规则的壁；45%的病例可见空洞；其他表现小叶中心结、树芽征、腺泡/小叶性实变；本例未见淋巴结肿大，但5%的病例可见。

细胞免疫功能受损的患者如（HIV、监狱里的、无家可归的）易感性增加。

最常见的体征/症状包括咳嗽、胸膜炎性胸痛，上呼吸道感染症状，咯血。

Q1——What is the most relevant finding?

Q2——Which of the following is the best description of the lesion in the right upper lobe?

Q3——There is evidence of an Aspergillus fungus ball formation.（霉菌球形成）

Q4——Lymphadenopathy 淋巴结肿大is the radiologic hallmark标志 of primary TB.

Q5——Due to the prolonged nature of the patient\’s exposure, respiratory isolation is not required pending culture.

Q6——Definitive diagnosis of active tuberculosis is based on which of the following?

Q7——The patient should be offered HIV screening.

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