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患者女,32岁。系“咳嗽咳痰发热2月,活动后胸闷气喘半月”于2012年2月6日入院。有鼻窦炎病史10余年,未正规检查,无烟酒嗜好,已婚,父母均体健,否认近亲结婚,其弟弟有长期慢性咳嗽病史,但未做正规检查。体格检查:T36.3℃,P113次/min,神志清楚,颈静脉无充盈。胸廓正常,叩诊正常清音,双肺呼吸音稍粗,双下肺可及少许干湿性罗音,右位心,HR113次/min,心律整齐,无杂音。全腹柔软,上腹部有轻压痛,叩诊肝上界位于左侧第5肋间隙上。神经系统检查(-)。外院胸部CT示:双侧支气管扩张伴感染。
Female patient, 32 years old. Department “cough and sputum fever in February, after activities, chest tightness and wheezing ” was admitted on February 6, 2012. A history of sinusitis more than 10 years, no formal examination, no alcoholic drinks and tobacco habits, married, parents are healthy, denied the marriage of a cousin, his brother had a long history of chronic cough, but did not do the formal examination. Physical examination: T36.3 ℃, P113 times / min, conscious, no filling of the jugular vein. Normal thorax, percussion normal voiceless, lung breath sounds a little thick, double lower lungs and a little wet and dry rales, right centripetal, HR113 times / min, rhythm and neat, no noise. Full abdomen soft, mild tenderness on the abdomen, percussion liver upper boundary is located on the left 5 intercostal space. Neurological examination (-). Outside the chest CT showed: bilateral bronchiectasis with infection.