每日一题_2023.04.13

A 34-year-old woman with tobacco use disorder was referred to the pulmonary clinic for worsening dyspnea and dry cough. She had chronic hypoxemic respiratory failure of unknown cause, requiring supplemental oxygen. Computed tomography of the chest showed diffuse ground-glass opacities and areas of peripheral consolidation but no basilar reticulations or honeycombing. Bronchoalveolar lavage was not diagnostic, so surgical lung biopsy was performed. Histopathological analysis showed extensive alveolar filling with pigment-laden macrophages. What is the most likely diagnosis?

一名34岁的女性因吸烟成瘾而被转介到肺科门诊，主要表现为气促和干咳加重。她患有原因不明的慢性低氧血症呼吸衰竭，需要额外的氧气支持。胸部计算机断层扫描显示弥漫性毛玻璃样浸润和周围实变区域，但无基底网格或蜂窝化改变。支气管肺泡灌洗未能提供确诊信息，因此进行了手术肺活检。组织学分析显示肺泡内充满含色素巨噬细胞。最可能的诊断是什么？

A. Desquamative interstitial pneumonia 脱屑性间质性肺炎

B. Diffuse alveolar hemorrhage 弥漫性肺泡出血

C. Idiopathic pulmonary fibrosis 特发性肺纤维化

D. Lipoid pneumonia 类脂性肺炎

E. Pulmonary alveolar proteinosis 肺泡蛋白沉积症

答案解析：

这些发现与脱屑性间质性肺炎一致，这是一种罕见的特发性间质性肺炎，与吸烟高度相关。开始使用戒烟计划和逐渐减少糖皮质激素剂量的治疗。

正确答案：A