Thanks:
Thanks to teacher Li Mengjie from Hebei for his dedication to the original case, too classic, collection.
Case reporting
Patient, male, 63 years old.
Main complaints: cough, sputum cough with chest tightness, holding breath for 3 days.
physical examination:
T 36.1°C; P 126 times/min; R 20 times/min; Bp 160/100mmHg,
Clear-headed, breathing is stable, and superficial lymph nodes are small throughout the body. Right lung percussion solid sound, left lung percussion clear sound, right lung breath sound is low, left lung breath sound is coarse, both lungs do not hear dry and wet rales, heart rate 126 beats / min, rhythm, no murmur. There is no tenderness in the whole abdomen, the liver and spleen are not touched under the ribs, and there is no edema of both lower limbs.
Auxiliary tests:
ECG: sinus tachycardia, heart rate 108 beats/min.
Random trace blood glucose: 6.4 mmol/L.
chest CT examination:
The big picture is marked by Teacher Liu Hongguang of Qingdao
Case analysis
The reason for the medical history, the patient has suffered from tuberculous pleurisy before, there is no money to treat the disease, there is no treatment, and this is it.
This example has a history of tuberculous pleurisy, bilateral onset, extensive pleural calcification, and large cystic foci and eggshell calcifications on the right side, and calcification of lymph nodes under the protrusion, supporting the idea that tuberculosis is the cause of this disease.
The lesson to be learned is that once tuberculous exudative pleurisy is diagnosed, pleural aspiration should be promptly and anti-tuberculosis therapy should be formalized so as not to delay diagnosis and treatment.
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Learn further
Overview, causes:
Cholesterol pleural effusions occur 5 times more commonly in men than in women.
Most commonly occurs in the right thoracic cavity.
The cause is unclear.
It is documented to be closely related to tuberculosis infection.
It may also be associated with rheumatoid arthritis, syphilis, diabetes, malignancy, chronic alcoholism, leprosy, and autonomic nervous system abnormalities.
pathogenesis:
The mechanism by which a large number of cholesterol crystals precipitate in the pleural fluid is unknown and may be related to the following factors:
Recurrent chronic inflammation of the pleura, making the pleura progressively thickened, poor absorption function, so that the cholesterol precipitated from the blood to the chest cavity is not easily absorbed back, and the cholesterol concentration in the pleural fluid produces precipitation and crystallization.
Disorders of fat metabolism in the body , increased cholesterol in the blood, and with changes in pleural permeability, cholesterol in the blood seeps out into the pleural fluid.
Cholesterol is destroyed by mycobacterium tuberculosis or changes in the lipid composition of the fungus;
Degeneration and necrosis of cells on the surface of the pleura or in the pleural fluid , the release of cholesterol;
It is also possible that a "specific reaction" occurs in the pleura after infection with tuberculosis bacteria, and the absorption of cholesterol in the blood is hypersorpted.
Clinical manifestations:
Clinical symptoms are milder, and symptoms of compression and systemic toxicity are fewer.
Effusion characteristics:
The effusion is colorless, cloudy or bloody, or milky, yellowish, orange-yellow, yellow-green, dark brown and other different colors, and yellow-white is more common.
Its outstanding features are: the effusion is often mixed with floating scaly, silky, shiny, refractive cholesterol crystals. Crystals can be seen deposited at the bottom of the tube after standing.
Sedimentary objective examination: many plate-like, needle-like, oblique square crystals can be seen, and red blood cells and fat particles can also be seen.
Note one thing:
It must be pointed out that there is no corresponding causal relationship between cholesterol crystals and the total amount of cholesterol in the blood.
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