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散在する小結節影を呈し極細径気管支鏡を用いたCTガイド下 …

41 2 2003 107.. CT . mycobacterium avium 1 . 1 2 1 1 1 . 1 1 3 4 . 1 5 1 . 65 X CT . 5 12 mm 7 CRP CEA CYFRA. mycobacterium avium M. avium PCR . Virtual bronchoscopy CT . S6b M. avium .. mycobacterium avium -intracellulare complex MAC .. mycobacterium avium . CT . mycobacterium avium pulmonary disease Multiple small nodules Non-tuberculous mycobacteriosis CT-guided transbronchial biopsy Virtual bronchoscopy .. mycobacterium avium -intrace- llulare complex MAC 80 65 . 1 . 3 .. MAC 55 63 .. 30 ! 41 20 61 .. 1 ! 25 36 61 .. MAC 8 .. mycobacterium avium M. avium 1 13 8 X . CT . 13 10 . 060 8638 15 7 . 1 . 1 . 2 . cm kg 2 . 3 138! 90 mmHg 87! .. 4 .. 5 .. 14 5 17 Table 1 .. 108 41 2 2003 . Table 1 Laboratory findings on admission Hematology Serology WBC 7,200/ l CRP mg/dl neutro Candida antigen.

a b とから,治療は行わず外来にて経過観察中である. 考察 MACとはMycobacterium avium-intracellulare complex の略であり,MAC症とはM. aviumMycobacterium in- tracellulare(M. intracellulare)の両者が同定された場合, あるいはM. avium 症とM. intracellulare 症の両者をまと めて言う場合に用いる.過去の報告では臨床像 ...

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  Mycobacterium, Mycobacterium avium, Avium

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Transcription of 散在する小結節影を呈し極細径気管支鏡を用いたCTガイド下 …

1 41 2 2003 107.. CT . mycobacterium avium 1 . 1 2 1 1 1 . 1 1 3 4 . 1 5 1 . 65 X CT . 5 12 mm 7 CRP CEA CYFRA. mycobacterium avium M. avium PCR . Virtual bronchoscopy CT . S6b M. avium .. mycobacterium avium -intracellulare complex MAC .. mycobacterium avium . CT . mycobacterium avium pulmonary disease Multiple small nodules Non-tuberculous mycobacteriosis CT-guided transbronchial biopsy Virtual bronchoscopy .. mycobacterium avium -intrace- llulare complex MAC 80 65 . 1 . 3 .. MAC 55 63 .. 30 ! 41 20 61 .. 1 ! 25 36 61 .. MAC 8 .. mycobacterium avium M. avium 1 13 8 X . CT . 13 10 . 060 8638 15 7 . 1 . 1 . 2 . cm kg 2 . 3 138! 90 mmHg 87! .. 4 .. 5 .. 14 5 17 Table 1 .. 108 41 2 2003 . Table 1 Laboratory findings on admission Hematology Serology WBC 7,200/ l CRP mg/dl neutro Candida antigen.

2 Lympho -D glucar pg/ml mono Mycoplasma antibody . eosino Cryptococcus antigen . baso Arterial blood gas analysis RBC 106/ l pH Hb g/dl PCO2 Torr Ht PO2 Torr Plt 104/ l HCO3 mmol/l ESR1h 12 mm/h Pulmonary function ESR2h 32 mm/h VC l Biochemistry %VC TP g/dl l . Alb g/dl . GOT 20 IU/l %DLco . GPT 21 IU/l %DLco/VA . LDH 352 IU/l Sputum ALP 198 IU/l Bacteria normal flora GTP 27 IU/l Tbc Ch-E 446 IU/l Smear . FBS 102 mg/dl Culture mycobacterium avium BUN 11 mg/dl PCR. Cr mg/dl mycobacterium avium . Na 141 mEq/l Cytology Class . K mEq/l PPD. Cl 101 mEq/l 0 0. 10 10 18 16 . CEA ng/ml . SCC ng/ml CA19-9 U/ml SLX U/ml CYFRA ng/ml . 1 12 mm CRP . Low attenuation area LAA . CEA ng! ml . CYFRA ng! ml M. avium . CEA CYFRA.. PCR 5 X . M. avium virtual bron- X Fig.

3 1 . choscopy S6b . 9 mm Olympus XP 40 . CT . H-E . 6 1 2. S b 12 10 mm S. CT Fig. 2 Fig. 3 . Ziehl-Neelsen Rhodamin . c 8 8 mm S6 S4 PCR M. avium 8 10. S S 5 mm 7 . 4 M. avium .. mycobacterium avium 1 109. Fig. 3 Histological examination of a transbronchial bi- opsy specimen, showing epitheloid cell granuloma H- E stain, 100 . Fig. 1 Chest radiograph on admission, showing a small nodular shadow in the right middle lung field arrow .. tracellulare M. intracellulare . M. avium M. intracellulare .. a MAC . M. avium M. avium . MAC 3 . 2 .. COPD.. 80 . b .. 5 10 mm .. MAC CT . MAC . 5 . Fig. 2 Chest CT scan on admission, showing multiple airspace consolidation . small nodular shadows without bronchiectasis in the left S 1 2 c a and in the right S 6 b b.

4 MAC mycobacterium avium -intracellulare complex . MAC M. avium mycobacterium in- . 110 41 2 2003 .. 1 Elizabeth H, Moore MD : Atypical mycobacterium infection in the Lung : CT appearance. Radiology MAC 1993 ; 187 : 777 782. 2 Hartman TE, Swensen SJ, Williams DE : Mycobacte- 6 . 7 . rium avium -intracellulare complex : Evaluation with CT. Radiology 1993 ; 187 : 23 26. MAC . 3 .. 1998 ; 288 294.. 4 American Thoracic Society Board of Directors, CT March 1990 : Diagnosis and treatment of disease caused by nontuberculous mycobacteria. Am Rev Respir Dis 1990 ; 142 : 940 953. 5 mycobacterium avium CT complex . 1998 ; 36 : 928 933. 6 . 2 cm mycobacterium avium complex 1 . 8 . 10 1996 ; 55 : 945 949.. 7 . 70 80 . MAC 1 .. 2001 ; 39 : 151 155.. 8 . B1a B1 2a.

5 CT . 2002 ; 40 : 11 16. 9 . CT 2000 ; 22 : Virtual 617 619. bronchoscopy 11 10 . 20 mm . M. avium CT .. 1999 ; 21 : 558 561. 11 .. Virtual bronchoscopy .. 2001 ; 23 : 12 . 223.. 12 .. 1998 ; 295 298. M. avium 13 . 13 . 1 2001 ; 39 : 669 704. 14 2 23 52 .. mycobacterium avium 1 111. Abstract A Case of mycobacterium avium Pulmonary Disease Detected as Multiple Small Nodular Shadows and Diagnosed by CT Guided Transbronchial Biopsy with Ultrathin Bronchoscopy Kaori Watanabe1 2 , Yasushi Shimizu1 , Satoshi Oizumi1 , Naofumi Shinagawa 1 , Ichiro Kinoshita 1 , Koichi Yamazaki1 , Yuya Onodera3 , Hiroshi Saito4 , Etsuro Yamaguchi1 , Hirotoshi Dosaka-Akita5 and Masaharu Nishimura1 . 1 . First Department of Medicine, Hokkaido University School of Medicine 2.

6 Second Department of Medicine, Hokkaido University School of Medicine 3 . Department of Radiology, Hokkaido University School of Medicine 4 . Department of Respiratory Disease, Kohnan Hospital, Federation of National Public Service and Affiliated Personnel Mutual Aid Association 5 . Department of Clinical Oncology, Hokkaido University Graduate School of Medicine A 65-year-old man was admitted to our hospital because multiple small nodular shadows measuring five to 12. mm in diameter in both lung fields were noticed on chest radiographs and CT scans during a regular checkup for pulmonary emphysema. The levels of ESR and CRP were within normal limits, but those of CEA and CYFRA. were slightly elevated. mycobacterium avium M. avium was detected in sputum cultures and in a sputum exami- nation using PCR.

7 Non-necrotizing granulomas were detected in the specimens obtained from a lesion of the right S 6 b by CT-guided transbronchial biopsy using an ultrathin bronchoscope after navigation with virtual broncho- scopy. On the basis of these findings, M. avium pulmonary disease was diagnosed. The patient is being followed up, but because he has no symptoms, without medication. To our knowledge, there have been no previous reports of M. avium -intracellulare complex pulmonary disease, which is characterized by multiple small nodular shadows. It is speculated that multiple centrilobular lesions developed simultaneously without extension to the bronchial walls, leading in this case to multiple small nodules in both lung fields.


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