Many people find "shadows" in the lungs when doing CT, and they are very nervous: is it "pneumonia", or "nodules" and "lung cancer"?
"Not all CT's 'inflammatory' manifestations are necessarily pneumonia." Dr. Wan Jun, deputy director of the Department of Respiratory and Critical Care Medicine at Beijing Anzhen Hospital, said that there is a lung disease with a high "disability" that also shows "inflammatory" characteristics under CT.
A 25-year-old young woman who came to the doctor because of chest pain in her right side was too much to breathe, and blood tests showed that white blood cells were a little higher, a bit like inflammation, and the emergency doctor also suspected pneumonia. But the patient did not have "inflammatory features", that is, she did not have a fever, no cough, and no phlegm.
Is this woman suffering from chest pain caused by pneumonia?
The emergency department invited Director Wan Jun to come to the consultation, and after seeing the patient's chest CT, 2 details attracted the attention of Director Wan Jun: First, there was a little bit of solid change at the bottom of the right lower lung with a ground glass shadow, and there was exudation (Figure 1).
Figure 1: Consolidation of the lower right lung with a ground glass shadow
"At the very bottom of the right lower lung, there is a solid with a ground glass shadow, indicating a lesion at the distal end, but this lesion does not see the common symptoms of pneumonia such as fever, chills, cough, and sputum production, but only chest pain." In addition to this point, which made Director Wan Jun highly vigilant, there was also a point that the patient's CT suggested mediastinal calcification (Figure 2).
Fig. 2 Mediastinal calcification
"Calcification of the mediastinum suggests a chronic inflammatory process in the mediastinum, meaning that the patient may have a disturbance in the distal vascular circulation." After looking at these two details, Director Wan Jun suggested that patients do CT pulmonary angiography.
The final CT diagnosis was mediastinitis with thrombosis and pulmonary infarction (Figure 3).
Fig. 3 Filling defect (thrombosis) in the right inferior pulmonary artery
pneumonia
Symptoms: fever, chills, cough, sputum cough, hemoptysis, chest pain
pulmonary embolism
Symptoms: chest pain, coughing up blood, dyspnea
Lung lesions under CT may be seen around or within the lungs
Lesions under CT are distributed around the lungs
Inflammation can also lead to blood clots in the lungs, which can also affect lung function
Many people have heard of pulmonary embolism because it was once called "economy class syndrome", mainly because the space in economy class is small, and travelers are sedentary, resulting in blood congestion in the veins of the lower limbs forming thrombuses, and blocking pulmonary arteries after thrombosis causes pulmonary embolism.
But the patient we are talking about today is obviously not caused by venous congestion in the lower extremities, but because there are blood clots caused by inflammation in the mediastinum.
Why does inflammation of the mediastinum cause thrombosis?
Director Wan Jun introduced that blood vessels, that is, the pathways of blood flow, are divided into arteries and veins. In general, the blood vessels that emanate from the heart are called arteries, including the aorta and pulmonary arteries. The blood vessels that send blood back to the heart are called veins, such as the pulmonary veins that go from the lungs back to the heart. Whether it is a pulmonary artery or a pulmonary vein, the blood in the lungs passes through the mediastinum. Once inflammation of the mediastinum is formed, the blood vessels of the lungs are also affected by inflammation, become narrow, and blood clots are formed.
Director Wan Jun introduced that there are many clinical examples of pulmonary embolism caused by mediastinitis. So, for this young woman, what caused inflammation of the mediastinum?
Beware, tuberculosis bacteria cause mediastinitis!
After the patient was hospitalized, he did a tracheoscopy and found that there was tuberculosis in the trachea where the mediastinum was inflamed, and tuberculosis bacteria were detected under the microscope, which was a tuberculosis of the bronchial lining and mediastinitis at the same time.
At this point, the 25-year-old young woman, without fever, cough, sputum, only the cause of chest pain was found, and a clear chain of disease was formed: tuberculosis mediastinitis pulmonary thrombosis pulmonary infarction right chest pain.
It is precisely because of Director Wan Jun's rich experience and careful observation that the particularity of the clinical manifestations and the 2 details of lung CT were found during the consultation, so that the patient was treated in a timely manner, and after anti-tuberculosis + anticoagulation treatment, the disease was controlled.
In fact, clinically, there are many examples of pulmonary intravascular thrombotic diseases being misdiagnosed, and once the delay in the condition will lead to complications, severe cases may affect heart and lung function. Damage to the heart and lungs caused by thrombotic blockages is often irreversible if they are not treated in time.
Finally, Director Wan Jun reminded the public: if there is no fever, cough, sputum cough and other manifestations of pneumonia, it is only chest pain, which may be a thrombosis problem in the blood vessels of the lungs! Be vigilant and seek medical attention in time!
Expert Profile Wan Jun
Doctor of Medicine, Chief Physician, Associate Professor, Master Supervisor, Standardized Training Instructor of The Department of Respiratory and Critical Care Medicine (PCCM). He is currently the deputy director of the Department of Respiratory and Critical Care Medicine and the executive deputy director of the Department of Infectious Diseases of Beijing Anzhen Hospital affiliated to Capital Medical University. He has long been engaged in respiratory and critical care medicine, and has rich experience in the diagnosis and treatment of difficult and critical diseases in respiratory medicine, especially in the diagnosis and treatment of pulmonary hypertension, pulmonary embolism and other diseases. He is a member of the expert group and core secretariat group of the Guidelines for the Diagnosis, Treatment and Prevention of Pulmonary Thromboembolism (2018 Edition) in China, a member of the core secretariat group of the Guidelines for the Prevention and Treatment of Thrombotic Diseases in China, a member of the Steering Group and the leader of the Secretariat Group of the Recommendations for the Prevention and Treatment of Venous Thromboembolism Related to Novel Coronavirus Pneumonia (Trial), and a member of the Draft Expert Group and the Writing Expert Group and the Leader of the Secretariat Group of the Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension in China (2021 Edition).
Source: Look at the breath
【Copyright Notice】This platform is a public welfare learning platform, reprinted for the purpose of transmitting more learning information, and has indicated the author and source, such as teachers who do not want to be disseminated can contact us to delete