有趣病例50：双肺弥漫性磨玻璃阴影，肿么办？
常记溪亭日暮，沉醉不知归路。
公众号：小小医生之有趣的医学
诗
人生天地常如客，
何独乡关定是家。
现在单发结节的指南遍地开花，但是没有双肺多发结节的指南；单发磨玻璃结节的指南满天飞，但是没人敢写弥漫性磨玻璃阴影的指南！
多发病灶，指“难”！
01
什么情况？
02
秀操作
A 40-year-old Chinese woman presented to the hospital with cough and a history of recurrent rash on the skin of the wrist and knee that disappeared spontaneously.
中年女性，咳嗽，伴可以自发缓解的手腕和膝盖皮疹。
皮疹，是一个线索！
Her personal and family history did not reveal anything remarkable, and reviews of systems were otherwise unremarkable.
个人史、家族史无特殊，系统回顾无特殊！
Physical examination revealed normal vital signs, no fever, clear lung fields on both sides, and no palpable lymphadenopathy.
体检：生命体征正常，无发热，双肺听诊清晰，未触及肿大淋巴结。
The results of routine lab investigations, including complete blood count and biochemistry, were normal.
常见的化验都是正常的。
03 肿么办？
无招！
做检查！
Flexible bronchoscopy and transbronchial biopsy of the lung parenchyma and bronchoalveolar lavage (BAL) were performed. The endoscopic findings did not reveal any endobronchial lesions.
支气管镜：未见异常。
The pathology report indicated the presence of epithelioid granulomas with no caseous necrosis.
支气管镜下肺活检：上皮样肉芽肿，没有干酪性坏死。
04 秀操作
我怎么感觉像结节病呢！
凭感觉不行！
外科肺活检！
行右侧胸腔镜检查，同时行右下叶楔形切除术。
病理：上皮细胞样肉芽肿，没有发现感染、肿瘤！
05 最终诊断
排除结核、真菌、肿瘤等，诊断为结节病！
06
治疗
As the patient reverted back to her general state of health, 40 mg/d of prednisone was administrated orally, and it was recommended that the corticosteroid therapy be continued for 1.5 years with tapering of the dose. HRCT was performed after 6 months; the corticosteroid therapy resulted in significant ablation of the ground glass opacity in the lung (Fig. 3a and b).
泼尼松40毫克，每天一次。
治疗前！
治疗半年后复查！
复杂的病例，基本无法秀操作！
07
Ma C , Zhao Y , Wu T . Predominant diffuse ground glass opacity in both lung fields: A case of sarcoidosis with atypical CT findings[J]. Respiratory Medicine Case Reports, 2016, 17(C):61-63.
09
杨柳岸，晓风残月。
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