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Ep 149: A 20-Year-Old with an Abnormal Chest X-Ray
2025/6/5
Harrison's PodClass: Internal Medicine Cases and Board Prep
C
Charlie Wiener
K
Kathy Handy
Charlie Wiener: 作为一名医生，我接诊了一位20岁的女大学生，她因胸部X光异常前来就诊。她主诉有持续10天的非生产性咳嗽、低烧和轻度呼吸困难，并且自测COVID、RSV和流感均为阴性。最令人担忧的是，她的小腿上出现了新的疼痛性红色皮肤病变。X光片显示她的肺部清晰，但双侧肺门和右侧气管旁有淋巴结肿大。我最初担心可能是淋巴瘤或其他恶性肿瘤，但考虑到她的年龄和症状，我开始考虑其他可能性。
Kathy Handy: 结合病史和检查结果，我认为这位患者很可能患有Lofgren综合征，这是结节病的一种特殊表现。Lofgren综合征通常发生在年轻人身上，以急性发作的结节性红斑、双侧肺门淋巴结肿大和发烧为特征。有时还会伴有游走性多关节炎和葡萄膜炎。虽然结节病的确切病因尚不清楚，但目前认为它是一种对感染性或非感染性环境因素的肉芽肿性炎症反应。值得庆幸的是，Lofgren综合征的预后通常非常好，多数患者无需特殊治疗即可自发缓解。因此，对于这位患者，我建议进行CT扫描以更好地评估淋巴结病变，并在排除其他潜在病因后，采取观察和对症治疗的策略。
Deep Dive
A 20-year-old college student presents with a 10-day history of cough, low-grade fever, mild dyspnea, and recently developed painful red skin lesions. Initial tests were negative for COVID, RSV, and Flu. Chest X-ray reveals clear lungs, a normal heart, but bilateral hilar and right paratracheal adenopathy. Skin exam shows red nodules on her lower legs.
- 20-year-old college student
- 10-day history of cough, low-grade fever, mild dyspnea
- negative COVID, RSV, and Flu tests
- chest x-ray: clear lungs, normal heart, bilateral hilar and right paratracheal adenopathy
- painful red nodules on lower legs
Shownotes Transcript
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