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首页> 外文期刊>The New England journal of medicine >Images in clinical medicine. Bilateral hilar and mediastinal lymphadenopathy.
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Images in clinical medicine. Bilateral hilar and mediastinal lymphadenopathy.

机译：临床医学中的图像。 双侧肝脏和纵隔淋巴结病。

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A 41-YEAR-OLD MAN PRESENTED TO THE EMERGENCY DEPARTMENT WITH a 9-month history of cough, exertional dyspnea, nocturnal diaphoresis, and weight loss of 10 kg. The physical examination revealed painless, massive cervical and supraclavicular lymphadenopathy. Plain radiography of the chest showed bilateral hilar lymphadenopathy (Panel A, arrows). The serum calcium level was elevated at 16.2 mg per deciliter (4 mmol per liter), prompting urgent intravenous administration of normal saline and a bisphosphonate. Other laboratory testing revealed an elevated lactate dehydrogrenase level of 1143 IU per liter and a serum parathyroid hormone level within the reference range. Computed tomographic imaging of the thorax, abdomen, and pelvis confirmed supradiaphragmatic lymphadenopathy in the hilar, mediastinal, and axillary regions (Panel B, arrows, and an image in the Supplementary Appendix, available with the full text of this article at NEJM.org). Excisional biopsy of an axillary lymph node established a diagnosis of Hodgkin's lymphoma, nodular sclerosis subtype. After 8 months of therapy, the patient had a good response to the chemotherapeutic regimen of doxorubicin, bleo-mycin, vinblastine, and dacarbazine. He has had no other therapy for the lymphoma but has been treated for complications associated with the chemotherapy.
机译：一名41岁男子介绍了急诊部门，咳嗽，富含呼吸困难，夜间膈肌，减肥10公斤。体检显示无痛，大规模的宫颈和上丙啶淋巴结病。胸部的纯射线照相显示双侧肺门淋巴结病（面板A，箭头）。血清钙水平以每分探测器16.2mg（每升4mmol）升高，促使急需静脉施用生理盐水和双膦酸盐。其他实验室检测显示，每升1143 IU的乳酸脱氢酶水平和参考范围内的血清甲状旁腺激素水平。计算的胸部，腹部和骨盆的断层摄影成像确认了综合症，纵隔和腋窝区域的Supradphragmatic淋巴结病，在NEJM.ORG中提供了本文的全文，可用） 。腋窝淋巴结的促进活检建立了霍奇金淋巴瘤，结节性硬化亚型的诊断。治疗8个月后，患者对多柔比星，BLEO-霉蛋白，长春毒素和达卡巴尿嘧啶的化学治疗方案具有良好的反应。他对淋巴瘤没有其他治疗，但已经治疗了与化疗相关的并发症。

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