NEJM临床病例支气管充气征

26岁女性患者，因狼疮性肾病继发终末期肾病，出现发热、咳嗽、气促等肺炎症状3天。逐渐发展为急性呼吸窘迫综合征（ARDS），因机械通气无效改用体外膜肺氧合（ECMO）。双腔膜肺导管置于右侧颈内静脉，从上下腔静脉引流出血液，并通过该导管回流至右心房。床旁前后位胸片示：双侧肺泡实变，肺透光度下降及支气管充气征，后者为周围肺泡透光度下降时，充气的支气管在胸片上的影像学表现。随后的支气管肺泡灌洗液培养提示卡他莫拉菌及流血嗜血杆菌阳性。患者接受合适的抗生素、肾脏替代治疗及支持治疗。9天后患者顺利脱离ECMO，13天后脱离机械通气。患者转入住院病人康复机构，随访期间6个月期间病情平稳。

A26-year-oldwomanwithend-stagerenaldiseasesecondarytolupusnephritispresentedwitha3-dayhistoryoffever,cough,andshortnessofbreath,symptomsthatareconsistentwithpneumonia.Theacuterespiratorydistresssyndrome(ARDS)developed,andthepatientultimatelyrequiredextracorporealmembraneoxygenation(ECMO)afterthefailureofmechanicalventilation.AduallumenECMOcatheterwasplacedintherightinternaljugularveintodrainbloodfromthesuperiorandinferiorvenacavaeandreturnittotherightatrium.Portableanterior–posteriorchestradiographyshoweddenseairspacediseasewithbilateralhemithoraxopacificationandairbronchograms,aradiologicsigninwhichtheair-filledbronchiarevisibleasaconsequenceoftheopacificationofthesurroundingalveoli.Shortlythereafter,culturesfrombronchoalveolarlavagerevealedMoraxellacatarrhalisandHaemophilusinfluenzae.Thepatientwastreatedwithappropriateantibiotics,renal-replacementtherapy,andsupportivecare.ShewassuccessfullyremovedfromtheECMOcircuitafter9daysandweanedfromthemechanicalventilator4dayslater.Shewasdischargedtoaninpatientrehabilitationfacilityandcontinuedtodowellatthe6-monthfollow-up.