A 22-year-old woman with bronchiectasis and a mediastinal mass.
A 22-year-old woman with bronchiectasis and a mediastinal mass.
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DOI：
10.1378/chest.13-0647
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发表时间：
2013-10
期刊：
影响因子：
9.6
通讯作者：
W. Hunt;J. S. Allam;G. Sica;B. Little;S. Veeraraghavan
中科院分区：
文献类型：
--
作者：
W. Hunt;J. S. Allam;G. Sica;B. Little;S. Veeraraghavan
A 22-year-old woman presented to the ED following several days of worsening shortness of breath and chest tightness associated with tachypnea and palpitations. Her past medical history was significant for several months of nausea and vomiting, crampy abdominal pain, intermittent loose stool, and weight loss. Severe gastritis and pyloric ulcers were discovered during an upper endoscopy approximately 1 month prior; she was treated with a proton pump inhibitor and sucralfate. She had previously been healthy and did not have a history of alcohol consumption, smoking, or intake of nonsteroidal antiinflammatory drugs. Her initial chest radiograph and chest CT scan are shown in Figures 1 and and2.2. She denied frequent respiratory illness as a child. Figure 1. Posteroanterior chest radiograph demonstrates upper lobe predominant scarring, architectural distortion, and subtle cystic and cylindrical bronchiectasis. Contour deformity of the right upper mediastinum with silhouetting of the ascending aortic contour ... Figure 2. A, Representative axial CT image displayed with lung window settings demonstrates architectural distortion and bilateral cystic and cylindrical bronchiectasis in the upper lobes and superior portion of the lower lobes. B, Mediastinal window demonstrates ... Physical Examination Findings On physical examination the patient was afebrile, with a heart rate of 113 beats/min, BP of 101/65 mm Hg, respiratory rate of 22 breaths/min, and oxygen saturation of 99% on room air. Neck examination revealed no thyromegaly, jugular venous distention, or cervical lymphadenopathy. Cardiac examination was notable for tachycardia. Bilateral inspiratory crackles were noted on lung auscultation. On abdominal examination she had diffuse mild tenderness to palpation without organomegaly. The rest of the physical examination was unremarkable. Laboratory Findings Laboratory findings showed a normal chemistry panel and normocytic anemia (hemoglobin=10.4 g/dL). Thyrotropin and free T4 levels were normal. Serum immunoglobulin levels showed IgG 354 mg/dL (normal, 694-1,698 mg/dL), IgA 40 mg/dL (normal, 63-378 mg/dL), and IgM 19 mg/dL (normal, 60-263 mg/dL). HIV test was negative. A bronchoscopy with BAL and transbronchial biopsy did not isolate any organisms and showed normal lung parenchyma. What is the next diagnostic step? What is the probable diagnosis? Next diagnostic step: Biopsy of the mediastinal mass Diagnosis: Good syndrome
