c********i
发帖数: 183 | 1 请问专家：
父亲在国内咳嗽（干咳）许久，最近腹胀。
1. B超检查后发现大量胸腔积液和腹腔积液；
2. 随后做了增强性CT（能照得都照了），CT所见，2测胸腔积液，左下肺噴胀不全，网
膜呈饼状增厚，腹腔及肠系根部多发结节，腹腔大量积液，双肾多发微小囊肿；其它未
见异常，没有淋巴结增大；
3. 血生化全项 --- 均正常；
4. 6项肿瘤指标（甲胎蛋白，癌胚抗原，糖链抗原199,细胞角蛋白19片段--- 就这个稍
微高一点是3。4，神经原特异性希醇化酶，糖链抗原），除了那个角蛋白片段高一点（
显示高0.1）其他都在正常范围；
5. 胃镜 --- 正常；
6. 肠镜 --- 发现两小块息肉，但是由于我爸清肠不完全，没有做切片或者切除--- 这
个我再让他们再做一次；
7. 结核菌痰培养---双阳性；
---- 于是按照结核性胸膜炎治疗，以上在综合性医院做的检查。结核培养阳性后转胸
科医院住院。
8. 穿刺抽水成血脓状，怀疑是转移性肿瘤，但是积液检查呈阴性，显示没有癌细胞，
积液检查至少两次了，均同样结果；
9. 核磁共振（能照得都照了）---- 正常。
现在的concern是5月2号住院，南京的胸科医院，到现在有至少两个礼拜了，开始只挂
保肝和抗结核药，上周中开始加消炎药，但是还是有很多胸水--- 且都是血脓状，每周
抽两次吧。有些同组医生建议做胸腔镜，但是提出会有风险。我父母就很保守，想再等
治疗一段时间看看。
我很担心，因为奶奶去世于原发性肺癌。虽然从目前看我爸检查结果还没有显示肿瘤阳
性，但是我总觉得如果单纯的结核性胸膜炎有那么严重吗？
跪求专家指点！！万分感谢！！ | M****0
发帖数: 877 | 2 I am not a specialist in this field. I will try to answer some of your
questions.
Based on what you have described,this is most likely TB with supra infection
with other bacteria. Cultures for other bacteria should also be sent which
I believe they did.
Usually we determine the pleural effusion as exudate vs transudate.
Sanguineous purulent pleural effusion is highly indicated exudate, and
infection and malignancy both could cause this type of pleural effusion.
Therefore, ruling out malignancy is appropriate, particularly there is a
family history.
Sometimes, if the amount of pleural effusion is large, repeat imagine
studies is indicated after remove the fluid as it could affect the
radiological diagnosis.
In terms of treatment, both standard anti-TB and strong antibiotics are
required. Surgery could speed up the healing, especially when it is widely
spread but I really doubt if your dad could tolerate surgery as you
mentioned that he has large amount of effusion in his lungs with part lung
collapsed, which definitely affected his pulmonary function.
但是我总觉得如果单纯的结核性胸膜炎有那么严重吗？
Yes, as it has already spread to other organs, apparently.
结核菌痰培养---双阳性!
Needs airborn isolation, otherwise, your other family members could be
affected.
Again, your information is just partial. Therefore, I would not take any
responsibility for all the above answers. | c********i
发帖数: 183 | 3 非常感谢楼上的回复！！医生却说不传染呢，因为不是肺，是胸膜，我也不懂。但是抽
完水再做影像的建议很make sense，多谢多谢！ |
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