每日一题_2023.05.26

A 50-year-old man with a history of mitral-valve prolapse and of Hodgkin’s lymphoma 20 years earlier presented to the emergency department with a 5-day history of dyspnea. Physical examination showed jugular venous distention, a holosystolic murmur at the cardiac apex, and diminished breath sounds in the lung bases. A radiograph of the chest was performed. What is the best next step in regard to the right lung opacity?

一名20年前有二尖瓣脱垂和霍奇金淋巴瘤病史的50岁男性因呼吸困难5日到急诊科就诊。体格检查:颈静脉扩张，心尖全收缩期杂音，肺底呼吸音减弱。进行了胸片检查。对于右肺混浊，下一步的最佳治疗方案是什么?

A. Collect a sputum culture and then initiate empiric antibiotics 收集痰培养，然后开始经验性抗生素治疗

B. Diurese the patient and then obtain a repeat chest radiograph 利尿，然后复查胸片

C. Obtain a computed tomography scan of chest 进行胸部计算机断层扫描

D. Perform a bronchoscopy 进行支气管镜检查

E. Perform a thoracentesis 进行胸腔穿刺术

答案解析：

正确的方法是给病人利尿，然后再做一次胸片。胸部x线片示肺容量超负荷，右肺中叶可见边界清楚的豆状阴影。超声心动图显示射血分数为45%，二尖瓣重度反流。给予利尿、扩血管治疗3 d后复查胸片示右肺混浊完全消退，肺水肿减轻。诊断为幻模瘤(也称为消失瘤或假瘤)。模体瘤是叶间囊性胸腔积液，最常发生在小裂处，如本例。

正确答案：B