有趣病例42：肺部莲花环面状征，lotus torus-like appearance
常记溪亭日暮，沉醉不知归路。
云南省一院 孙丹雄
诗
骚人墨客爱莲花！
留得残荷听雨声！
今天分享一个非常有趣的征象：'lotus torus-like' appearance，我把它翻译为“莲花环面状”征！
01
蛙刺this？
什么情况？
02
03
左下叶，小盆友的鼻涕泡！
外形像肿块，边界清楚，有分页，有毛刺，有鼻涕泡，典型的肺腺癌！
04 莲花环征
34岁日本妇女！
乍一看，典型的肺腺癌！
05 临床不孤立
临床医生看CT，要综合分析！
年轻人诊断肺癌要慎重！患者34岁，不宜盲目的切肺！
(A) Chest X-ray at the time of the diagnosis showing a mass shadow (arrow). (B) Chest CT showing the shadow of a 35×25-mm mass with a lotus torus-like appearance. (C) A lotus torus. (D) Swelling of the mediastinal lymph nodes (arrows).
莲花环征！
双侧纵隔淋巴结肿大（D，箭头）！
肺腺癌要考虑！
但是，不一定是！
感觉吧，这个淋巴结肿大，有点那个！
什么那个？
感觉，这个肿块，应该没有那么早双侧纵隔淋巴结肿大！这个淋巴结肿大，有点对称，有可能是结节病！
06
病理
A transbronchial lung biopsy and mediastinal lymph node biopsy led to the diagnosis of sarcoidosis.
支气管镜下肺活检+纵隔淋巴结活检：结节病！
07
随访
The natural course of the mass with a lotus torus-like appearance. (A) Six months and (B, C) twelve months after the diagnosis.
This lotus torus-like mass regressed spontaneously.
这个肿块，居然自发的缓解了！
纵隔淋巴结也缩小了！
早期结节病，不治疗也会自行缓解！
江湖神医：肺癌吃了我的保健品，神奇的肿块缩小了！犇！
08
A 34-year-old Japanese woman exhibited a 35×25-mm solitary multiloculated mass shadow in the left lower lobe mimicking lung adenocarcinoma. On computed tomography, the mass resembled a lotus torus. A transbronchial lung biopsy and mediastinal lymph node biopsy led to the diagnosis of sarcoidosis. This lotus torus-like mass regressed spontaneously. This is the second reported case of pulmonary cavitary sarcoidosis with a 'lotus torus-like' appearance. We propose several findings regarding the lotus torus-like appearance by comparing the findings to those of lung adenocarcinoma. Knowledge of this unique sign may be helpful for the differential diagnosis of pulmonary sarcoidosis from lung adenocarcinoma.
09
This is the second reported case of pulmonary cavitary sarcoidosis with a 'lotus torus-like' appearance.
这是世界上第二例报道的结节病导致的莲花环征！
这个患者，要是不做支气管镜，盲目的把肺切了，就很不划算！
Kanaji N, Nakashima N, Inoue T, Ibuki E, Murota M, Kadowaki N. Pulmonary Multiloculated 'Lotus Torus-like' Sarcoidosis Mimicking Lung Adenocarcinoma. Intern Med. 2019 Feb 1;58(3):419-422.
10
杨柳岸，晓风残月。
视频
有些事情，虽然很无聊，很不符合逻辑，很神经病，但是，很搞笑！