 History: A 76-year-old man presents with an intermittent cough for the past three months. He also complains of shoulder and pelvic pain increasing in intensity for the last six months without any history of trauma. He also has noticed a 10-lb weight loss in this time period. 病史：患者男，76岁，主要表现为间歇性咳嗽3月。还自诉过去6个月肩旁、骨盆疼痛加剧，没有创伤史。这段时间体重减轻10磅。 Anteroposterior and lateral chest radiographs were obtained. 胸部正侧位平片如下： Findings Radiographs: Radiography shows innumerable small, randomly distributed, solid pulmonary micronodules with an apical predominance. 影像表现： CT: CT chest also shows innumerable small, randomly distributed, solid pulmonary micronodules with an apical predominance. On CT, these nodules are seen to involve the fissures and pleura surfaces, making a centrilobular distribution unlikely. There is also a fairly even distribution throughout the affected lung and relative sparing of the bronchovascular interstitium, making a perilymphatic distribution also less likely. The overall distribution is, therefore, most suggestive of random distribution. Additional salient findings include axillary adenopathy, findings suggestive of a septic shoulder joint and evidence of healed granulomatous infection. CT：胸部CT可见多发小的、随机分布的、实性微结节，以肺尖部为主。在CT上，如果结节累及肺裂和胸膜表面，则呈中央小叶型分布结节，不太像。若结节累及肺，播散至支气管血管间质，则呈淋巴管周围分布，也不像。因此，综合所有分布类型，提示随机分布结节的可能性最大。此外，最明显的征象还包括腋窝淋巴结肿大，该征象提示肩关节脓毒性感染，证明有愈合肉芽肿性感染。 Diagnosis: Miliary tuberculosis 粟粒性肺结核 Notes： 1. pulmonary [ˈpʌlməneri] adj. 肺的 2. apical ['æpɪkəl] adj. 顶上的 3. fissure [ˈfɪʃɚ] n. 肺裂 4. pleura [ˈplʊrə] n. 胸膜 5. bronchovascular [brɒntʃə'væskjʊlə] 支气管血管的 6. interstitium [ɪntəs'tɪʃəm] 间质组织 7. axillary [æksɪlərɪ] adj. 腋窝的 8. granulomatous [ˌgrænjʊ'loʊmətəs] 肉芽肿的 来源：每天朗读一段医学影像学英语文章 圈主 深圳市人民医院放射科副主任医师杨敏洁 |
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