目的 探讨结核病在18氟-脱氧葡萄糖（18F-FDG）正电子发射断层扫描术（PET）中的影像学表现，提高对PET/CT在肺部包块诊断作用的认识，减少误诊。 方法 回顾分析2010年3月收治的1例肺结核合并纵隔淋巴结结核病患者的误诊及诊断治疗经过，分析误诊原因并总结诊治经验，结合文献复习肺部包块在PET/CT中的表现及临床特点。 结果 患者为肺部包块伴纵隔淋巴结包块，胸部CT提示肺癌伴纵隔淋巴结转移，PET/CT也考虑左肺下叶肺癌伴淋巴结转移。最后经纵隔镜淋巴结活检确诊结核，并抗结核治疗好转。 结论 结核等感染性疾病常可导致18F-FDG的摄取增加而造成PET/CT阳性结果，因此在18F-FDG PET/CT呈现阳性结果时须注意鉴别病变良恶性，其中高标准摄入值包块尤其需要注意与结核病相鉴别。
ObjectiveTo investigate a more convenient and safe sampling method for viral nucleic acid detection of coronavirus disease 2019.MethodsAn oropharyngeal swab and nasopharyngeal swab were simultaneously taken from 100 patients with coronavirus disease 2019 in a hospital in Wuhan. Then the efficacies of two sampling methods were compared on the positive rates of viral nucleic acid detection.ResultsThe positive rate for SARS-CoV-2 was 54% in oropharyngeal swabs, while 89% positive in nasopharyngeal swabs. There was a significant difference in the detection rate between oropharyngeal swab and nasopharyngeal swab (χ2=3.850 4, P=0.049 7).ConclusionsThe positive rate for nucleic acid testing from nasopharyngeal swabs are significantly better than that from oropharyngeal swabs. Therefore, sampling by nasopharyngeal swabs, rather than oropharyngeal swabs, should be chosen as the preferred virological screening method for patients with coronavirus disease 2019.
The diagnosis of coronavirus disease 2019 should not only depend on nucleic acid test, but also be based on clinical information such as medical history and radiographic findings. It’s critical to identify patients with high risk of rapid progression. Treatment of coronavirus disease 2019 should be individualized according to the underlying diseases and progression manner. For severely ill patients, oxygen and nutrition supplementation need to be strengthened, and for some highly selected cases, administration of glucocorticoids might be beneficial.