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病例32-2017:一名呼吸困难、哮鸣、头痛、咳嗽和盗汗的64岁男性
Case 32-2017 — A 64-Year-Old Man with Dyspnea, Wheezing, Headache, Cough, and Night Sweats


Kerri Palamara ... 其他 • 2017.10.19

病历陈述


Amulya Nagarur医师:一名64岁男性因呼吸困难、哮鸣、头痛、咳嗽和盗汗被送入本院急诊科。

此次就诊前大约6年,该患者在另一家医院经风湿病科医师诊断为纤维肌痛。就诊前2年,患者突发右侧腰部和臀部疼痛,合并右腿感觉减退、乏力。磁共振成像(MRI)显示L5~S1腰骶椎间盘突出,右侧椎间孔中重度狭窄。针刺肌电图显示右侧L5神经根病变。神经外科医师会诊建议理疗,并给予了2次糖皮质激素注射,症状得到改善。但是,2个月后肌电图显示右侧L5神经根病变持续活动,自上次检查以来没有得到改善。

此次就诊前大约1年半,该患者的风湿科医师报告患者出现持续性右足下垂和椎旁肌持续压痛。此外,基于逐渐出现的双手和腕部不适以及手部感觉异常诊断为腕管综合征。

就诊前大约5个月,患者自觉开始咳嗽,并咳稀薄黄色痰。接下来的一个月开始出现劳累性呼吸困难、胸闷及哮鸣。6周后(此次就诊前9周),患者在另一家医院由他的初级保健医师进行了检查。检查发现干啰音及哮鸣,其余未发现异常。实验室检查结果见表1。胸片结果正常。患者被诊断为支气管炎,并给予了沙丁胺醇吸入剂和阿奇霉素。由于考虑过敏性支气管炎,患者被转诊到变态反应科医师处。





作者信息

Kerri Palamara, M.D., Amulya Nagarur, M.D., Florian J. Fintelmann, M.D., Minna J. Kohler, M.D., and Frank B. Cortazar, M.D.
From the Departments of Medicine (K.P., A.N., M.J.K., F.B.C.) and Radiology (F.J.F.), Massachusetts General Hospital, and the Departments of Medicine (K.P., A.N., M.J.K., F.B.C.) and Radiology (F.J.F.), Harvard Medical School — both in Boston.

 

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