tailieunhanh - DIAGNOSIS & TREATMENT - PART 2

Viêm phế quản tắc nghẽn ở người lớn-còn được gọi là cryptogenic tổ chức viêm phổi có thể theo nhiễm trùng (ví dụ, mycoplasma, nhiễm virus), có thể là do hít phải khói độc hại hoặc có liên quan với bệnh mô liên kết hoặc cấy ghép nội tạng, có thể làm phức tạp các tổn thương phổi địa phương | 40 Essentials of Diagnosis Treatment 2 Bronchiolitis Obliterans With Organizing Pneumonia BOOP Essentials of Diagnosis Bronchiolitis obliterans in adults also called cryptogenic organizing pneumonia may follow infections eg mycoplasma viral infection may be due to toxic fume inhalation or associated with connective tissue disease or organ transplantation may complicate local lung lesions or may be idiopathic Usually characterized by abrupt onset of flu-like symptoms including dry cough dyspnea fever and weight loss Dry crackles and wheezing by auscultation clubbing rare Restrictive abnormalities with pulmonary function studies hypoxemia Chest radiograph typically shows patchy alveolar infiltrates bilaterally Open or thoracoscopic lung biopsy necessary for precise diagnosis Differential Diagnosis Idiopathic pulmonary fibrosis AIDS-related lung infections Congestive heart failure Mycobacterial or fungal infection Severe pneumonia due to bacteria fungi or tuberculosis Treatment Corticosteroids effective in two-thirds of cases Relapse common after short 6 months steroid courses Pearl One of the new diseases consider this when there is untimely resolution of an infiltrate in what you thought was a community-acquired pneumonia. Reference Epler GR Bronchiolitis obliterans organizing pneumonia. Arch Intern Med 2001 161 158. PMID 11176728 Chapter 2 Pulmonary Diseases 41 Solitary Pulmonary Nodule Essentials of Diagnosis A round or oval circumscribed lesion less than 5 cm in diameter surrounded by normal lung tissue Twenty-five percent of cases of bronchogenic carcinoma present as such the 5-year survival rate so detected is 50 Factors favoring benign lesion age under 35 years asymptomatic status size under 2 cm diffuse calcification smooth margins and satellite lesions Factors suggesting malignancy age over 45 years symptoms size greater than 2 cm lack of calcification indistinct margins smoking history Skin tests serologies cytology rarely helpful Comparison with old chest