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[NEJM临床医学影像]:意外发现的油胸
2017年04月14日 临床影像, 临床话题 暂无评论

Images in Clinical Medicine

Incidental Finding of Oleothorax

Abhilash Koratala, Vikrampal Bhatti.

N Engl J Med 2017; 376; e21

DOI:10.1056/NEJMicm1609176

 

An 86-year-old woman with hypertension who had been treated for pulmonary tuberculosis in the 1950s presented with burning chest and epigastric pain. She had no respiratory symptoms. After acute coronary syndrome was ruled out, she was treated for gastroesophageal reflux, which relieved her symptoms. A chest radiograph showed a dense opacity in the upper area of the left lung. The differential diagnosis for this abnormality includes an old calcified empyema, hemothorax, and oleothorax. Given her history of treatment for tuberculosis, the most likely diagnosis was oleothorax — a treatment for pulmonary tuberculosis, abandoned long ago, that involved the instillation of oil into the pleural space to collapse the involved lung. Typically, after treatment, which could last up to 2 years, the oil was aspirated. However, asymptomatic patients were sometimes lost to follow-up and the oil was left in place, as occurred in this patient. Long-term complications, including superimposed infection and airway obstruction, have been reported. This patient had no complications or symptoms related to oleothorax.

一名86岁女性高血压患者于50年代因肺结核曾接受治疗。患者因胸部烧灼感及上腹部疼痛就诊。患者没有呼吸道症状。排除急性冠脉综合征后,按照胃食道返流进行治疗,症状缓解。胸片显示左上肺一致密不透光影。鉴别诊断包括陈旧钙化脓胸,血胸及人工油胸。根据患者曾接受抗结核治疗的病史,最可能的诊断为油胸—这是肺结核的一种治疗方法,已废弃多年,指将油注入胸膜腔造成受累肺组织塌陷。通常,在治疗后(可长达2年)应将油吸出。然而,无症状患者有时会失访,这样油就未能吸出,正如此患者的情况。报道的长期并发症包括继发感染及气道梗阻。此患者没有并发症或油胸相关症状。

 

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