Sarcoidosis with a Pulmonary Disseminated Miliary Nodule Presentation: A Case Report and Review

類肉瘤以肺部散佈性粟狀節結作爲表現

陳宏杰(Hung-Jie Chen) ； 曾若琦(Jo-Chi Tseng) ； 劉育志(Yu-Chih Liu)

《胸腔醫學》 23卷2期 (2008/04) Pp. 103-111

https://doi.org/10.29806/TM.200804.0005

摘要

類肉瘤(sarcoidosis)是一種慢性肉芽腫(granuloma)的病變。它可以侵犯肺，心臟，皮膚，神經系統，淋巴系統等。其中以肺部侵犯最為常見。常見的肺部侵犯的臨床症狀包括喘、咳嗽、胸闷、胸痛等。在影像學上，胸部X光片可分為五期。第0期：正常，第1期：雙側肺門淋巴結病變，第2期：瀰漫性肺部浸潤合併雙側肺門淋巴結病變，第3期：瀰漫性肺部浸潤，第4期：肺纖維化。但以尚多發性粟粒狀節結作為表現，是甚為少見。
本病例報告描寫一個年輕女性，在健診中意外發現肺部瀰漫性粟狀節結無合併其他臨床症狀。肺功能呈現中度限制性肺疾病。高解析電腦斷層(high-resolution computed tomography, HRCT)呈現出中下肺葉較明顯的瀰漫性粟粒狀節結。而有關肺結核感染得檢查包括痰液，細菌PCR皆呈現陰性反應。在電視輔助式胸腔鏡手術(Video-assisted thoracoscopic surgery, VATS)的肺生檢切片下，病理學報告是非乾酪性壞死肉芽腫，符合類肉瘤診斷。此病患接受口服類固醇治療，在治療兩個月後，我們追蹤肺功能，並發現肺功能已回到正常值。之復追蹤胸部X光片和高解析電腦斷層之肺部浸潤結節均獲得改善。

關鍵字

類肉瘤 ； 粟狀結節 ； 類固醇

並列摘要

Sarcoidosis is a systemic disease, and lung involvement is most common. The radiologic patterns of sarcoidosis are usually lymphadenopathy, diffuse lung infiltrations, and multiple nodular lesions. We report a female patient with asymptomatic miliary nodular infiltrations found by routine chest X-ray. The pulmonary function test showed moderately restrictive lung disease. Lung biopsy using video-assisted thoracic surgery (VATS) was performed, and the pathology report revealed non-caseous granulomatous inflammation. All studies for tuberculosis infection were negative, including tuberculin skin test, sputum acid fast stain, and bronchial wash fluid and culture. Under the impression of sarcoidosis, oral corticosteroid treatment was prescribed. After steroid treatment, the patient's lung infiltration and lung function test both improved.

並列關鍵字

sarcoidosis ； military nodules ； corticosteroid