H\u00ecnh 1. C\u1eadn l\u00e2m s\u00e0ng h\u00ecnh \u1ea3nh Xquang v\u00e0 CT ng\u1ef1c<\/figcaption><\/figure>\nH\u00ecnh \u1ea3nh Xquang ng\u1ef1c ch\u1ee5p 7 th\u00e1ng tr\u01b0\u1edbc l\u1ea7n nh\u1eadp vi\u1ec7n n\u00e0y (h\u00ecnh A) cho th\u1ea5y \u0111\u00e1m m\u1edd kh\u00f4ng r\u00f5 r\u00e0ng \u1edf th\u00f9y d\u01b0\u1edbi ph\u1ed5i ph\u1ea3i (d\u1ea5u hoa th\u1ecb). Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh tr\u1ee5c \u0111\u1ee9ng (CT) ng\u1ef1c khi b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n l\u1ea7n n\u00e0y (h\u00ecnh B v\u00e0 C) cho th\u1ea5y h\u00ecnh \u1ea3nh k\u00ednh m\u1edd \u1edf d\u1ea1ng l\u00e1t \u0111\u00e1 ch\u1ee7 y\u1ebfu ph\u1ed5i ph\u1ea3i (h\u00ecnh B, d\u1ea5u hoa th\u1ecb), c\u0169ng nh\u01b0 h\u00ecnh \u1ea3nh \u0111\u00f4ng \u0111\u1eb7c th\u00f9y d\u01b0\u1edbi ph\u1ed5i ph\u1ea3i (h\u00ecnh C, d\u1ea5u hoa th\u1ecb) ph\u00e2n b\u1ed1 \u1edf c\u00e1c m\u1ea1ch m\u00e1u quanh ph\u1ebf nang v\u1edbi h\u00ecnh k\u00ednh m\u1edd (h\u00ecnh C, d\u1ea5u hoa th\u1ecb tr\u1eafng). H\u00ecnh CT ng\u1ef1c thu \u0111\u01b0\u1ee3c c\u1eeda s\u1ed5 trung th\u1ea5t trong l\u1ea7n nh\u1eadp vi\u1ec7n hi\u1ec7n t\u1ea1i (h\u00ecnh D) cho th\u1ea5y \u0111\u00e1m m\u1edd \u0111\u00f4ng \u0111\u1eb7c v\u1edbi c\u00e1c v\u00f9ng gi\u1ea3m \u0111\u1eadm \u0111\u1ed9 \u1edf th\u00f9y d\u01b0\u1edbi ph\u1ed5i ph\u1ea3i. \u0110o t\u1ef7 tr\u1ecdng c\u1ee7a v\u00f9ng \u0111\u00f4ng \u0111\u1eb7c gi\u1ea3m \u0111\u1eadm \u0111\u1ed9 th\u1ea5y gi\u1ea3m th\u1ea5p (trung b\u00ecnh, -84 \u0111\u01a1n v\u1ecb Hounsfield [HU]). \u0110\u01b0\u1eddng th\u1eb3ng trong h\u00ecnh D ch\u1ec9 v\u00f9ng gi\u1ea3m \u0111\u1eadm \u0111\u1ed9 \u0111\u01b0\u1ee3c \u0111o.<\/p>\n
Ti\u1ec1n s\u1eed c\u00f3 lo \u00e2u, t\u0103ng m\u1ee1 m\u00e1u, \u0111au n\u1eeda \u0111\u1ea7u, nh\u01b0\u1ee3c gi\u00e1p v\u00e0 \u0111au m\u1ea1n t\u00ednh do b\u1ec7nh \u0111\u0129a \u0111\u1ec7m c\u1ed9t s\u1ed1ng c\u1ed5, m\u1eb7c d\u00f9 \u0111\u00e3 ti\u1ebfn h\u00e0nh c\u1eaft \u0111\u1ed1t s\u1ed1ng C6-C7. Kho\u1ea3ng 8 n\u0103m nay, h\u00e0ng n\u0103m b\u1ec7nh nh\u00e2n \u0111\u1ec1u b\u1ecb c\u00e1c \u0111\u1ee3t vi\u00eam ph\u1ebf qu\u1ea3n c\u00f3 tri\u1ec7u ch\u1ee9ng nh\u01b0 ho, sung huy\u1ebft ph\u1ed5i v\u00e0 ho c\u00f3 \u0111\u00e0m, th\u01b0\u1eddng gi\u1ea3m sau khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng glucocorticoide v\u00e0 azythromycine. B\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng c\u00e1c thu\u1ed1c nh\u01b0 amitriptyline, clonaz-pam, evolocumab, lamotrigine, levothyroxine v\u00e0 oxycodone-acetamynophen \u0111\u1ec3 gi\u1ea3m \u0111au. B\u1ec7nh nh\u00e2n b\u1ecb d\u1ecb \u1ee9ng v\u1edbi c\u00e1c s\u1ea3n ph\u1ea9m c\u00f3 ch\u1ee9a sulfonamide v\u00e0 c\u00f3 c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 do d\u00f9ng c\u1ea3 fluroquinolone v\u00e0 statin. B\u1ec7nh nh\u00e2n h\u00fat thu\u1ed1c kho\u1ea3ng 1\/2 g\u00f3i m\u1ed7i ng\u00e0y t\u1eeb n\u0103m 18 tu\u1ed5i nh\u01b0ng \u0111\u00e3 ng\u01b0ng 3 th\u00e1ng tr\u01b0\u1edbc khi nh\u1eadp vi\u1ec7n. B\u1ec7nh nh\u00e2n c\u00f3 d\u00f9ng thu\u1ed1c l\u00e1 \u0111i\u1ec7n t\u1eed ch\u1ee9a ch\u1ea5t g\u00e2y nghi\u1ec7n v\u00e0i l\u1ea7n trong h\u01a1n 1 n\u0103m tr\u01b0\u1edbc l\u1ea7n nh\u1eadp vi\u1ec7n n\u00e0y. B\u1ec7nh nh\u00e2n kh\u00f4ng s\u1eed d\u1ee5ng c\u1ea7n sa, kh\u00f4ng nghi\u1ec7n r\u01b0\u1ee3u ho\u1eb7c ti\u00eam ch\u00edch c\u00e1c ch\u1ea5t c\u1ea5m. B\u1ec7nh nh\u00e2n kh\u00f4ng ti\u1ebfp x\u00fac v\u1edbi b\u1ea5t k\u1ef3 \u0111\u1ed9ng v\u1eadt n\u00e0o. G\u1ea7n \u0111\u00e2y b\u1ec7nh nh\u00e2n du l\u1ecbch \u0111\u1ebfn Florida. Ch\u1ecb g\u00e1i m\u1eafc vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p v\u00e0 m\u1eb9 b\u1ecb ung th\u01b0 bu\u1ed3ng tr\u1ee9ng. B\u1ec7nh nh\u00e2n l\u00e0m vi\u1ec7c t\u1ea1i trung t\u00e2m ch\u0103m s\u00f3c ng\u01b0\u1eddi cao tu\u1ed5i nh\u01b0ng \u0111\u00e3 v\u1ec1 h\u01b0u.<\/p>\n
Ti\u1ec1n s\u1eed b\u1ec7nh nh\u00e2n h\u00fat thu\u1ed1c 20 g\u00f3i-n\u0103m v\u00e0 \u0111\u00e3 ghi nh\u1eadn c\u00e1c \u0111\u1ee3t c\u1ea5p vi\u00eam ph\u1ebf qu\u1ea3n h\u00e0ng n\u0103m c\u00f3 th\u1ec3 g\u00e2y b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn ti\u1ec1m \u1ea9n. M\u1eb7c d\u00f9 h\u00fat thu\u1ed1c l\u00e1 \u0111i\u1ec7n t\u1eed (vape) li\u00ean quan t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i, b\u1ec7nh nh\u00e2n ch\u1ec9 d\u00f9ng v\u00e0i l\u1ea7n v\u00e0 kh\u1edfi ph\u00e1t c\u00e1c tri\u1ec7u ch\u1ee9ng tho\u00e1ng qua xu\u1ea5t hi\u1ec7n r\u1ea5t l\u00e2u sau khi b\u1ec7nh nh\u00e2n d\u00f9ng vape l\u1ea7n cu\u1ed1i; do \u0111\u00f3, h\u00fat thu\u1ed1c l\u00e1 \u0111i\u1ec7n t\u1eed kh\u00f4ng gi\u1ed1ng th\u00fac \u0111\u1ea9y ch\u1ee7 y\u1ebfu b\u1ec7nh c\u1ea3nh l\u1ea7n n\u00e0y. M\u1eb7c d\u00f9 th\u1ef1c t\u1ebf ch\u1ecb b\u1ec7nh nh\u00e2n b\u1ecb vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p, b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed b\u1ea3n th\u00e2n g\u1ee3i \u00fd b\u1ec7nh m\u00f4 li\u00ean k\u1ebft c\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng \u1edf ph\u1ed5i ti\u1ec1m n\u0103ng. B\u1ec7nh nh\u00e2n c\u0169ng kh\u00f4ng ti\u1ebfp x\u00fac r\u00f5 r\u00e0ng v\u1edbi c\u00e1c ch\u1ea5t m\u00e0 g\u00e2y vi\u00eam ph\u1ed5i qu\u00e1 m\u1eabn hay b\u1ec7nh b\u1ee5i phph\u1ed50<\/p>\n
Kh\u00e1m l\u00e2m s\u00e0ng, nhi\u1ec7t \u0111\u1ed9 36.8 \u0111\u1ed9 C, nh\u1ecbp tim 96 l\u1ea7n\/ph\u00fat, huy\u1ebft \u00e1p 142\/63mmHg, nh\u1ecbp th\u1edf 18 l\u1ea7n\/ph\u00fat, \u0111\u1ed9 b\u00e3o h\u00f2a Oxy 93% (b\u1ec7nh nh\u00e2n th\u1edf O2 qua cannula m\u0169i 2 l\u00edt\/ph\u00fat. C\u00e1c d\u1ea5u hi\u1ec7u sinh t\u1ed3n kh\u00e1c b\u00ecnh th\u01b0\u1eddng. B\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 r\u0103ng h\u00e0m d\u01b0\u1edbi, kh\u00f4ng t\u1ed5n th\u01b0\u01a1ng hay lo\u00e9t mi\u1ec7ng. B\u1ec7nh nh\u00e2n c\u0169ng kh\u00f4ng c\u00f3 t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i. Ti\u1ebfng tim b\u00ecnh th\u01b0\u1eddng, kh\u00f4ng c\u00f3 ti\u1ebfng c\u1ecd m\u00e0ng tim, kh\u00f4ng \u00e2m th\u1ed5i, kh\u00f4ng ti\u1ebfng ng\u1ef1a phi. B\u1ec7nh nh\u00e2n c\u00f3 kh\u1ea3 n\u0103ng h\u00edt v\u00e0o b\u00ecnh th\u01b0\u1eddng nh\u01b0ng nghe ran ng\u00e1y lan t\u1ecfa v\u00e0 nge ti\u1ebfng kh\u00f2 kh\u00e8 th\u00ec th\u1edf ra. B\u1ee5ng m\u1ec1m, \u1ea5n kh\u00f4ng \u0111au, kh\u00f4ng ch\u01b0\u1edbng b\u1ee5ng v\u00e0 gan l\u00e1ch kh\u00f4ng to. B\u1ec7nh nh\u00e2n c\u00f3 ban \u0111\u1ecf l\u00f2ng b\u00e0n tay v\u00e0 ban \u0111\u1ecf m\u1eb7t c\u1ed5 \u1edf m\u0169i, m\u00e1, c\u1eb1m v\u00e0 c\u1ed5. B\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 ph\u00e1t ban kh\u00e1c v\u00e0 kh\u00f4ng vi\u00eam bao ho\u1ea1t d\u1ecbch, kh\u00f4ng tr\u00e0n d\u1ecbch v\u00e0 kh\u00f4ng \u0111au kh\u1edbp. Tay ch\u00e2n \u1ea5m v\u00e0 t\u01b0\u1edbi m\u00e1u t\u1ed1t, kh\u00f4ng ph\u00f9 ngo\u1ea1i bi\u00ean.<\/p>\n
Ti\u1ebfng kh\u00f2 kh\u00e8 th\u00ec th\u1edf ra v\u00e0 ran ng\u00e1y c\u00f3 th\u1ec3 do s\u1ef1 n\u1eb7ng th\u00eam c\u1ee7a b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh ho\u1eb7c c\u00e1c qu\u00e1 tr\u00ecnh li\u00ean quan t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng th\u1edf c\u1ea5p t\u00ednh, nh\u01b0 d\u1ecbch ti\u1ebft, c\u00e1c th\u01b0\u01a1ng t\u1ed5n ho\u1eb7c vi\u00eam nhi\u1ec5m. M\u1eb7c d\u00f9 ban \u0111\u1ecf l\u00f2ng b\u00e0n tay th\u01b0\u1eddng li\u00ean quan b\u1ec7nh gan, \u0111\u00e2y c\u0169ng l\u00e0 tri\u1ec7u ch\u1ee9ng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u v\u00ec c\u0169ng xu\u1ea5t hi\u1ec7n tr\u00ean b\u1ec7nh nh\u00e2n c\u01b0\u1eddng gi\u00e1p v\u00e0 c\u00e1c b\u1ec7nh th\u1ea5p kh\u1edbp m\u00e0 c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng \u1edf ph\u1ed5i, nh\u01b0 vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p v\u00e0 vi\u00eam da c\u01a1. Ban \u0111\u1ecf \u1edf m\u0169i v\u00e0 m\u00e1 c\u00f3 th\u1ec3 ph\u00f9 h\u1ee3p h\u1ed3ng ban c\u00e1nh b\u01b0\u1edbm m\u00e0 th\u01b0\u1eddng do lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng, m\u1ed9t b\u1ec7nh c\u00f3 th\u1ec3 do bi\u1ebfn ch\u1ee9ng c\u1ee7a xu\u1ea5t huy\u1ebft ph\u1ebf nang, vi\u00eam ph\u1ed5i v\u00e0 b\u1ec7nh ph\u1ed5i m\u00f4 k\u1ebd. C\u00e1c b\u1ec7nh c\u1ea3nh th\u1ea5p kh\u1edbp kh\u00e1c li\u00ean quan b\u1ec7nh ph\u1ed5i m\u1ea1n t\u00ednh nh\u01b0 u h\u1ea1t do vi\u00eam \u0111a m\u1ea1ch, h\u1ed9i ch\u1ee9ng Sjogren v\u00e0 x\u01a1 c\u1ee9ng b\u00ec, c\u0169ng n\u00ean \u0111\u00e1nh gi\u00e1 b\u1eb1ng c\u00e1ch \u0111o c\u00e1c d\u1ea5u \u1ea5n vi\u00eam th\u00edch h\u1ee3p v\u00e0 x\u00e9t nghi\u1ec7m t\u1ef1 kh\u00e1ng th\u1ec3.<\/p>\n
S\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u l\u00e0 8.960\/mm3 (b\u00ecnh th\u01b0\u1eddng 4.000-10.000), v\u1edbi c\u00e1c th\u00e0nh ph\u1ea7n b\u1ea1ch c\u1ea7u kh\u00e1c b\u00ecnh th\u01b0\u1eddng. Hemoglo[1]bin l\u00e0 13.5 g\/dl (b\u00ecnh th\u01b0\u1eddng 11.5-16.4 g\/ dl) v\u00e0 s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u l\u00e0 412.000\/mm3 (b\u00ecnh th\u01b0\u1eddng 150.000-450.000). Creatinin, \u0111i\u1ec7n gi\u1ea3 \u0111\u1ed3, bicarbonate, ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn, procalcitonin, creatine kinase v\u00e0 aldolase \u0111\u1ec1u b\u00ecnh th\u01b0\u1eddng, x\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng gan c\u0169ng b\u00ecnh th\u01b0\u1eddng. M\u1ee9c lactate dehydrogenase l\u00e0 244 U\/ L (b\u00ecnh th\u01b0\u1eddng 135-225). C\u00e1c b\u1ed9 x\u00e9t nghi\u1ec7m virus \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p nh\u01b0 PCR \u0111\u1ec3 ph\u00e1t hi\u1ec7n SARS-CoV-2 RNA, x\u00e9t nghi\u1ec7m n\u01b0\u1edbc ti\u1ec3u t\u00ecm c\u00e1c kh\u00e1ng nguy\u00ean legioella v\u00e0 ph\u1ebf c\u1ea7u, v\u00e0 x\u00e9t nghi\u1ec7m virus g\u00e2y suy gi\u1ea3m mi\u1ec5n d\u1ecbch \u1edf ng\u01b0\u1eddi \u0111\u1ec1u \u00e2m t\u00ednh. Thyrotropin l\u00e0 0.4 \u03bcIU\/ml (b\u00ecnh th\u01b0\u1eddng 0.5-5.7) v\u00e0 thyroxine l\u00e0 7.2 \u03bcg\/dl (b\u00ecnh th\u01b0\u1eddng 4.6-10.7 \u03bcg\/dl [59 – 138 nmol\/l]). T\u1ed1c \u0111\u1ed9 l\u1eafng h\u1ed3ng c\u1ea7u l\u00e0 16mm\/h (b\u00ecnh th\u01b0\u1eddng 0-39) v\u00e0 protein C ph\u1ea3n \u1ee9ng \u0111\u1ed9 nh\u1ea1y cao l\u00e0 3.4 mg\/l (b\u00ecnh th\u01b0\u1eddng 0-3). C3 l\u00e0 203 mg\/dl (b\u00ecnh th\u01b0\u1eddng 90-180) v\u00e0 C4 l\u00e0 20 mg\/dl (b\u00ecnh th\u01b0\u1eddng l\u00e0 10-40). X\u00e9t nghi\u1ec7m y\u1ebfu t\u1ed1 th\u1ea5p d\u01b0\u01a1ng t\u00ednh, v\u1edbi \u0111\u1ed9 chu\u1ea9n 22 IU\/ml (gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng <13) v\u00e0 m\u1ed9t x\u00e9t nghi\u1ec7m c\u00e1c\u00a0 kh\u00e1ng th\u1ec3 peptide cittrullinated kh\u00e1ng v\u00f2ng \u0111\u1ec1u \u00e2m t\u00ednh. C\u00e1c x\u00e9t\u00a0 nghi\u1ec7m\u00a0 kh\u00e1ng\u00a0 th\u1ec3 kh\u00e1ng phospholipide, kh\u00e1ng th\u1ec3 kh\u00e1ng nh\u00e2n, kh\u00e1ng th\u1ec3 kh\u00e1ng b\u00e0o t\u01b0\u01a1ng b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh v\u00e0 kh\u00e1ng Smith, kh\u00e1ng Jo-1, kh\u00e1ng chu\u1ed7i \u0111\u00f4i DNA, kh\u00e1ng RNP, kh\u00e1ng Scl-10 v\u00e0 kh\u00e1ng th\u1ec3 kh\u00e1ng centromere \u0111\u1ec1u \u00e2m t\u00ednh.<\/p>\n
X\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh nh\u00e2n cho th\u1ea5y s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u b\u00ecnh th\u01b0\u1eddng v\u00e0 m\u1ee9c procalcitonin c\u0169ng b\u00ecnh th\u01b0\u1eddng, do \u0111\u00f3 l\u00e0m gi\u1ea3m nghi ng\u1edd c\u00f3 vi\u00eam ph\u1ed5i do vi khu\u1ea9n. C\u00e1c k\u1ebft qu\u1ea3 b\u1ea5t th\u01b0\u1eddng trong x\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng tuy\u1ebfn gi\u00e1p c\u00f3 th\u1ec3 do li\u1ec7u ph\u00e1p thay th\u1ebf hormone gi\u00e1p qu\u00e1 m\u1ee9c. T\u0103ng nh\u1eb9 y\u1ebfu t\u1ed1 th\u1ea5p th\u00ec c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng kh\u00f4ng ch\u1eafc ch\u1eafn m\u00e0 b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111au kh\u1edbp v\u00e0 kh\u00f4ng vi\u00eam bao ho\u1ea1t d\u1ecbch l\u00fac kh\u00e1m. C\u00e1c k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m kh\u00e1c kh\u00f4ng g\u1ee3i \u00fd c\u00f3 qu\u00e1 tr\u00ecnh c\u1ee7a b\u1ec7nh t\u1ef1 mi\u1ec5n.<\/p>\n
\u0110i\u1ec7n t\u00e2m \u0111\u1ed3 ghi nh\u1eadn nh\u1ecbp nhanh xoang nh\u01b0ng kh\u00f4ng \u0111\u00e1ng k\u1ec3. Ch\u1ee5p m\u1ea1ch m\u00e1u ph\u1ed5i CT ng\u1ef1c (h\u00ecnh 1B \u0111\u1ebfn 1D) cho th\u1ea5y h\u00ecnh k\u00ednh m\u1edd \u0111a \u1ed5, v\u1edbi m\u1ed9t s\u1ed1 v\u00f9ng xu\u1ea5t hi\u1ec7n h\u00ecnh \u1ea3nh l\u00e1t \u0111\u00e1, c\u0169ng nh\u01b0 \u0111\u00e1m m\u1edd \u0111\u00f4ng \u0111\u1eb7c \u1edf c\u00e1c v\u00f9ng gi\u1ea3m \u0111\u1eadm \u0111\u1ed9 (-84 \u0111\u01a1n v\u1ecb Hounsfield) ph\u00e2n b\u1ed1 ch\u1ee7 y\u1ebfu m\u1ea1ch m\u00e1u quanh ph\u1ebf nang. N\u1ed5i h\u1ea1ch b\u1ea1ch huy\u1ebft trung th\u1ea5t v\u00e0 r\u1ed1n ph\u1ed5i v\u00e0 kh\u00ed ph\u1ebf th\u1ee7ng nh\u1eb9 ch\u1ee7 y\u1ebfu th\u00f9y tr\u00ean c\u1ea3 2 ph\u1ed5i c\u0169ng xu\u1ea5t hi\u1ec7n. Kh\u00f4ng t\u00ecm th\u1ea5y huy\u1ebft kh\u1ed1i trong ph\u1ed5i. \u0110\u00e1m m\u1edd \u0111\u00f4ng \u0111\u1eb7c \u1edf ph\u1ed5i ph\u1ea3i t\u00ecm th\u1ea5y tr\u00ean phim CT l\u00fac b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n l\u1ea7n cu\u1ed1i c\u00f9ng \u0111\u00e3 gi\u1ea3m, nh\u01b0ng l\u1ea1i xu\u1ea5t hi\u1ec7n h\u00ecnh k\u00ednh m\u1edd v\u1edbi h\u00ecnh l\u00e1t \u0111\u00e1. B\u1ec7nh b\u1ea1ch huy\u1ebft kh\u00f4ng thay \u0111\u1ed5i m\u1ed9t c\u00e1ch r\u00f5 r\u00e0ng.<\/p>\n
M\u1eb7c d\u00f9 ch\u1ee5p nhi\u1ec1u h\u00ecnh \u1ea3nh \u0111\u1ec3 theo d\u00f5i \u0111\u00f4ng \u0111\u1eb7c trong th\u00f9y gi\u1eefa ph\u1ed5i ph\u1ea3i \u0111\u00e3 gi\u1ea3m, c\u00e1c b\u1eb1ng ch\u1ee9ng Xquang ph\u1ed5i k\u00e9o d\u00e0i sau khi \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh th\u00edch h\u1ee3p b\u1ec7nh l\u00fd nhi\u1ec5m tr\u00f9ng do MSSA l\u00e0m d\u1ea5y l\u00ean lo ng\u1ea1i c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c ngo\u00e0i nhi\u1ec5m tr\u00f9ng do vi khu\u1ea9n. H\u00ecnh \u1ea3nh l\u00e1t \u0111\u00e1, v\u1edbi s\u1ef1 xu\u1ea5t hi\u1ec7n d\u00e0y v\u00e1ch li\u00ean th\u00f9y x\u1ebfp ch\u1ed3ng l\u00ean nhau, l\u00e0 d\u1ea5u hi\u1ec7u kh\u00f4ng \u0111\u1eb7c hi\u1ec7u li\u00ean quan b\u1ec7nh nhi\u1ec5m tr\u00f9ng, c\u00e1c b\u1ec7nh t\u0103ng sinh, vi\u00eam nhi\u1ec5m v\u00e0 vi\u00eam ph\u1ed5i h\u00edt ho\u1eb7c h\u00edt c\u00e1c ch\u1ea5t nhi\u1ec1u lipid. Tr\u00ean h\u00ecnh \u1ea3nh h\u1ecdc, c\u00e1c gi\u00e1 tr\u1ecb gi\u1ea3m \u0111\u1eadm \u0111\u1ed9 (nh\u01b0 -150-30 \u0111\u01a1n v\u1ecb Hounsfield) ph\u00f9 h\u1ee3p v\u1edbi s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a m\u1ee1. Nhi\u1ec1u h\u00ecnh \u1ea3nh k\u00ednh m\u1edd gi\u1ea3m \u0111\u1eadm \u0111\u1ed9, h\u00ecnh l\u00e1t \u0111\u00e1 v\u00e0 n\u1ed5i h\u1ea1ch b\u1ea1ch huy\u1ebft thu\u1ed9c r\u1ea5t nhi\u1ec1u b\u1ec7nh \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t, nh\u01b0 vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh, b\u1ec7nh t\u00edch t\u1ee5 protein ph\u1ebf nang ph\u1ed5i, vi\u00eam ph\u1ed5i t\u1eafc ngh\u1ebdn(vi\u00eam ph\u1ed5i do lipid n\u1ed9i sinh), vi\u00eam ph\u1ed5i t\u1ed5 ch\u1ee9c, nhi\u1ec5m tr\u00f9ng kh\u00f4ng \u0111i\u1ec3n h\u00ecnh v\u00e0 ung th\u01b0 bi\u1ebfu m\u00f4 tuy\u1ebfn ch\u1ea5t nh\u1ea7y ho\u1eb7c lepidic chi\u1ebfm \u01b0u th\u1ebf.<\/p>\nH\u00ecnh 2. H\u00ecnh n\u1ed9i soi ph\u1ebf qu\u1ea3n b\u1eb1ng \u1ed1ng soi m\u1ec1m<\/figcaption><\/figure>\nN\u1ed9i soi ph\u1ebf qu\u1ea3n th\u1ef1c hi\u1ec7n v\u00e0o ng\u00e0y th\u1ee9 3 t\u1eeb l\u00fac nh\u1eadp vi\u1ec7n cho th\u1ea5y d\u1ecbch ti\u1ebft \u0111\u1ee5c nh\u01b0 s\u1eefa trong nh\u00e1nh ph\u1ebf qu\u1ea3n th\u00f9y d\u01b0\u1edbi ph\u1ed5i ph\u1ea3i.<\/p>\n
Ng\u00e0y th\u1ee9 3 t\u1eeb l\u00fac nh\u1eadp vi\u1ec7n, n\u1ed9i soi ph\u1ebf qu\u1ea3n b\u1eb1ng \u1ed1ng soi m\u1ec1m (h\u00ecnh 2) cho th\u1ea5y nhi\u1ec1u d\u1ecbch ti\u1ebft \u0111\u1ee5c nh\u01b0 s\u1eefa \u1edf c\u1ea3 2 ph\u1ed5i. M\u1ed9t s\u1ed1 v\u00f9ng ni\u00eam m\u1ea1c ph\u1ebf qu\u1ea3n trong ph\u1ed5i ph\u1ea3i c\u00f3 h\u00ecnh \u1ea3nh \u0111\u00e1 cu\u1ed9i. M\u1eabu BAL l\u1ea5y t\u1eeb th\u00f9y d\u01b0\u1edbi v\u00e0 gi\u1eefa ph\u1ed5i ph\u1ea3i. X\u00e9t nghi\u1ec7m vi sinh h\u1ecdc c\u00e1c m\u1eabu b\u1ec7nh ph\u1ea9m \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p, nh\u01b0 c\u1ea5y vi khu\u1ea9n hi\u1ebfu kh\u00ed v\u00e0 y\u1ebfm kh\u00ed, c\u1ea5y n\u1ea5m v\u00e0 ph\u1ebft t\u1ebf b\u00e0o tr\u1ef1c khu\u1ea9n nhanh b\u1eb1ng acid \u0111\u1ec1u \u00e2m t\u00ednh. D\u1ecbch BAL ch\u1ee7 y\u1ebfu b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh. X\u00e9t nghi\u1ec7m t\u1ebf b\u00e0o h\u1ecdc d\u1ecbch BAL t\u00ecm ra c\u00e1c \u0111\u1ea1i th\u1ef1c b\u00e0o v\u1edbi c\u00e1c kh\u00f4ng b\u00e0o t\u1ebf b\u00e0o ch\u1ea5t l\u1edbn. Ch\u1ecdc h\u00fat b\u1eb1ng kim nh\u1ecf c\u00e1c h\u1ea1ch b\u1ea1ch huy\u1ebft trung th\u1ea5t v\u00e0 r\u1ed1n ph\u1ed5i cho th\u1ea5y kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng ung th\u01b0. M\u1eabu sinh thi\u1ebft nh\u00e1nh ph\u1ebf qu\u1ea3n sau th\u00f9y gi\u1eefa ph\u1ed5i ph\u1ea3i v\u00e0 m\u1eabu sinh thi\u1ebft xuy\u00ean ph\u1ebf qu\u1ea3n c\u1ee7a th\u00f9y gi\u1eefa v\u00e0 d\u01b0\u1edbi ph\u1ed5i ph\u1ea3i \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n. X\u00e9t nghi\u1ec7m m\u00f4 h\u1ecdc c\u00e1c m\u1eabu n\u00e0y ph\u00e1t hi\u1ec7n \u0111\u1ea1i th\u1ef1c b\u00e0o v\u1edbi c\u00e1c kh\u00f4ng b\u00e0o l\u1edbn \u0111\u01b0\u1ee3c tr\u1ed9n v\u1edbi c\u00e1c t\u1ebf b\u00e0o kh\u1ed5ng l\u1ed3 \u0111a nh\u00e2n hi\u1ec7n di\u1ec7n trong \u0111\u01b0\u1eddng th\u1edf v\u00e0 trong v\u00e1ch ph\u1ebf nang v\u00e0 khoang k\u1ebd. C\u00e1c b\u1eb1ng ch\u1ee9ng n\u00e0y gi\u00fap \u0111\u01b0a ra ch\u1ea9n \u0111o\u00e1n vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh, m\u1ed9t r\u1ed1i lo\u1ea1n do h\u00edt ph\u1ea3i c\u00e1c ch\u1ea5t gi\u00e0u lipid m\u1ea1n t\u00ednh.<\/p>\n
C\u00e1c d\u1ea5u hi\u1ec7u vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh trong x\u00e9t nghi\u1ec7m m\u00f4 h\u1ecdc \u0111\u1eb7t ra c\u00e1c c\u00e2u h\u1ecfi quan tr\u1ecdng v\u1ec1 ti\u1ebfp x\u00fac c\u00e1c ch\u1ea5t gi\u00e0u lipid. Quan tr\u1ecdng l\u00e0 ph\u1ea3i khai th\u00e1c k\u1ef9 c\u00e0ng ti\u1ec1n s\u1eed \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ngu\u1ed3n g\u1ed1c h\u00edt ph\u1ea3i lipid b\u1edfi v\u00ec \u0111i\u1ec1u tr\u1ecb ch\u1ee7 y\u1ebfu c\u1ee7a vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh l\u00e0 tr\u00e1nh ti\u1ebfp x\u00fac v\u1edbi ngu\u1ed3n lipid \u0111\u00f3.<\/p>\nNhu\u1ed9m hematoxylin v\u00e0 eosin c\u1ee7a ch\u1ebf ph\u1ea9m kh\u1ed1i t\u1ebf b\u00e0o d\u1ecbch r\u1eeda ph\u1ebf qu\u1ea3n-ph\u1ebf nang<\/figcaption><\/figure>\nNhu\u1ed9m hematoxylin v\u00e0 eosin ch\u1ee9a m\u1eabu sinh thi\u1ebft xuy\u00ean ph\u1ebf qu\u1ea3n<\/figcaption><\/figure>\nR\u1eeda ph\u1ebf qu\u1ea3n-ph\u1ebf nang v\u00e0 c\u00e1c m\u1eabu sinh thi\u1ebft xuy\u00ean ph\u1ebf qu\u1ea3n. Nhu\u1ed9m hematoxylin v\u00e0 eosin c\u1ee7a ch\u1ebf ph\u1ea9m kh\u1ed1i t\u1ebf b\u00e0o d\u1ecbch r\u1eeda ph\u1ebf qu\u1ea3n-ph\u1ebf nang (m\u1eabu A) v\u00e0 nhu\u1ed9m hematoxylin v\u00e0 eosin ch\u1ee9a m\u1eabu sinh thi\u1ebft xuy\u00ean ph\u1ebf qu\u1ea3n (m\u1eabu B) cho th\u1ea5y c\u00e1c \u0111\u1ea1i th\u1ef1c b\u00e0o v\u1edbi r\u1ea5t nhi\u1ec1u kh\u00f4ng b\u00e0o t\u1ebf b\u00e0o ch\u1ea5t l\u1edbn ph\u1ea3n \u00e1nh c\u00e1c gi\u1ecdt lipid \u0111\u00e3 r\u1eeda s\u1ea1ch. M\u1ed9t s\u1ed1 m\u1eabu lipid hi\u1ec7n di\u1ec7n trong c\u00e1c \u0111\u1ea1i th\u1ef1c b\u00e0o \u0111\u01b0\u1eddng th\u1edf, trong khi \u0111\u00f3 m\u1ed9t s\u1ed1 l\u1ea1i k\u1ebft h\u1ee3p \u1edf khoang k\u1ebd (m\u1eabu B, m\u0169i t\u00ean) th\u00f4ng qua t\u1ed5 ch\u1ee9c nguy\u00ean b\u00e0o s\u1ee3i. C\u00e1c b\u1eb1ng ch\u1ee9ng n\u00e0y x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sin.<\/p>\n
Khi \u0111\u01b0\u1ee3c h\u1ecfi th\u00eam, b\u1ec7nh nh\u00e2n khai l\u00e0 c\u00f3 u\u1ed1ng d\u1ea7u kho\u00e1ng nh\u01b0 m\u1ed9t lo\u1ea1i thu\u1ed1c nhu\u1eadn tr\u00e0ng trong 10 n\u0103m qua. B\u1ec7nh nh\u00e2n u\u1ed1ng kho\u1ea3ng 3 mu\u1ed7ng canh d\u1ea7u kho\u00e1ng t\u1eeb 2-3 l\u1ea7n m\u1ed7i tu\u1ea7n ngay tr\u01b0\u1edbc khi \u0111i ng\u1ee7. B\u1ec7nh nh\u00e2n c\u0169ng d\u00f9ng son d\u01b0\u1ee1ng m\u00f4i ch\u1ee9a d\u1ea7u v\u00e0 paraffin 3 l\u1ea7n\/ ng\u00e0y. B\u1ec7nh nh\u00e2n kh\u00f4ng d\u00f9ng d\u1ea7u gan c\u00e1 hay c\u00e1c ch\u1ea5t b\u1ed5 sung t\u01b0\u01a1ng t\u1ef1. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c y\u00eau c\u1ea7u l\u00e0m m\u1ed9t \u0111\u00e1nh gi\u00e1 v\u1ec1 nu\u1ed1t t\u1ea1i gi\u01b0\u1eddng cho th\u1ea5y kh\u00f4ng c\u00f3 h\u00edt s\u1eb7c, nh\u01b0ng khi th\u1ef1c hi\u1ec7n nghi\u1ec7m ph\u00e1p nu\u1ed1t bari ti\u1ebfp theo th\u00ec ghi nh\u1eadn r\u1ed1i lo\u1ea1n nu\u1ed1t th\u1ef1c qu\u1ea3n.<\/p>\n
B\u1edfi v\u00ec vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng h\u00edt ph\u1ea3i, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 kh\u00f3 kh\u0103n trong vi\u1ec7c nu\u1ed1t. B\u1ec7nh \u0111\u1ed1t s\u1ed1ng c\u1ed5 v\u00e0 can thi\u1ec7p ph\u1eabu thu\u1eadt k\u1ebft h\u1ee3p b\u1ec7nh \u0111\u1ed1t s\u1ed1ng c\u1ed5, nh\u01b0 b\u1ec7nh nh\u00e2n n\u00e0y m\u1eafc ph\u1ea3i, c\u00f3 th\u1ec3 l\u00e0 bi\u1ebfn ch\u1ee9ng do kh\u00f3 nu\u1ed1t th\u1ef1c qu\u1ea3n v\u00e0 r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng th\u1ef1c qu\u1ea3n. B\u1ec7nh nh\u00e2n c\u00f3 \u0111\u00e1nh gi\u00e1 nu\u1ed1t b\u00ecnh th\u01b0\u1eddng nh\u01b0ng l\u1ea1i r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng th\u1ef1c qu\u1ea3n c\u00f3 th\u1ec3 g\u00e2y n\u00ean h\u00edt ph\u1ea3i kh\u00f4ng ch\u1ee7 \u00fd, \u0111\u1eb7c bi\u1ec7t d\u1ea7u kho\u00e1ng b\u1ec7nh nh\u00e2n u\u1ed1ng ngay tr\u01b0\u1edbc khi \u0111i ng\u1ee7. Nhi\u1ec1u ch\u1ea5t gi\u00e0u lipid \u0111\u01b0\u1ee3c c\u00e1c nh\u00e0 nghi\u00ean c\u1ee9u m\u00f4 t\u1ea3 l\u00e0 c\u00f3 li\u00ean quan vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh, bao g\u1ed3m d\u1ea7u kho\u00e1ng, paraffin v\u00e0 petrolatum, t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n n\u00e0y \u0111\u1ec1u s\u1eed d\u1ee5ng li\u00ean t\u1ee5c. Trong th\u1eddi gian n\u1eb1m vi\u1ec7n, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c cho tr\u00ec ho\u00e3n d\u00f9ng glucocorticoide v\u00e0 kh\u00e1ng sinh. B\u1ec7nh nh\u00e2n c\u0169ng ng\u01b0ng th\u1edf oxy t\u1eeb ng\u00e0y 4 nh\u1eadp vi\u1ec7n, v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng t\u1ef1 thuy\u00ean gi\u1ea3m. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c khuy\u00ean ng\u01b0ng d\u00f9ng d\u1ea7u kho\u00e1ng v\u00e0 son m\u00f4i. B\u1ec7nh nh\u00e2n c\u0169ng \u0111\u01b0\u1ee3c t\u01b0 v\u1ea5n c\u00e1c bi\u1ec7n ph\u00f2ng ng\u1eeba do h\u00edt ph\u1ea3i, bao g\u1ed3m tr\u00e1nh \u0103n tr\u01b0\u1edbc khi \u0111i ng\u1ee7 v\u00e0 khuy\u1ebfn kh\u00edch k\u00ea cao \u0111\u1ea7u khi ng\u1ee7. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c xu\u1ea5t vi\u1ec7n v\u00e0o ng\u00e0y th\u1ee9 7. Ch\u1ee5p l\u1ea1i CT ng\u1ef1c sau 1 th\u00e1ng xu\u1ea5t vi\u1ec7n cho th\u1ea5y kh\u00f4ng c\u00f2n thay \u0111\u1ed5i n\u00e0o \u0111\u00e1ng ng\u1ea1i v\u1ec1 k\u00ednh m\u1edd loang \u0111a \u1ed5 v\u00e0 \u0111\u00e1m m\u1edd \u0111\u00f4ng \u0111\u1eb7c; tuy nhi\u00ean, t\u00ecnh tr\u1ea1ng kh\u00f3 th\u1edf \u0111\u00e3 gi\u1ea3m \u0111\u00e1ng k\u1ec3 v\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111i b\u1ed9 2 d\u1eb7m m\u00e0 kh\u00f4ng g\u1eb7p v\u1ea5n \u0111\u1ec1 h\u00f4 h\u1ea5p n\u1eefa. Ran ng\u00e1y v\u1eabn c\u00f2n khi nghe ph\u1ed5i, nh\u01b0ng b\u1ec7nh nh\u00e2n \u0111\u00e3 h\u1ebft kh\u00f2 kh\u00e8 th\u00ec th\u1edf ra v\u00e0 \u0111\u1ed9 b\u00e3o h\u00f2a oxy duy tr\u00ec kho\u1ea3ng 96% khi h\u00edt kh\u00ed tr\u1eddi.<\/p>\n
B\u00e0n lu\u1eadn<\/h2>\n Trong ca n\u00e0y, b\u1ec7nh nh\u00e2n kh\u00f3 th\u1edf v\u00e0 ho t\u00e1i di\u1ec5n, c\u00f3 h\u00ecnh \u1ea3nh k\u00ednh m\u1edd xu\u1ea5t hi\u1ec7n h\u00ecnh l\u00e1t \u0111\u00e1. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t ban \u0111\u1ea7u r\u1ea5t nhi\u1ec1u g\u1ed3m nhi\u1ec5m tr\u00f9ng, vi\u00eam nhi\u1ec5m v\u00e0 c\u00e1c qu\u00e1 tr\u00ecnh t\u0103ng sinh. Sau c\u00f9ng, c\u00e1c b\u1eb1ng ch\u1ee9ng trong x\u00e9t nghi\u1ec7m t\u1ebf b\u00e0o h\u1ecdc d\u1ecbch BAL v\u00e0 x\u00e9t nghi\u1ec7m m\u00f4 h\u1ecdc m\u1eabu sinh thi\u1ebft xuy\u00ean ph\u1ebf qu\u1ea3n gi\u00fap th\u00e0nh l\u1eadp ch\u1ea9n \u0111o\u00e1n vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh c\u00f3 ti\u1ec1n s\u1eed u\u1ed1ng d\u1ea7u kho\u00e1ng.<\/p>\n
Vi\u00eam ph\u1ed5i do lipid l\u00e0 m\u1ed9t r\u1ed1i lo\u1ea1n \u0111\u1eb7c tr\u01b0ng do t\u00edch t\u1ee5 lipid n\u1ed9i sinh ho\u1eb7c ngo\u1ea1i sinh trong ph\u1ebf nang.<\/p>\n
Vi\u00eam ph\u1ed5i do lipid n\u1ed9i sinh ph\u1ea3n \u00e1nh s\u1ef1 t\u00edch t\u1ee5 lipid n\u1ed9i sinh, ch\u1ee7 y\u1ebfu trong ph\u1ebf nang; \u0111\u00e2y kh\u00f4ng ph\u1ea3i r\u1ed1i lo\u1ea1n \u0111\u1eb7c hi\u1ec7u thay v\u00e0o \u0111\u00f3 l\u00e0 th\u00e0nh ph\u1ea7n c\u00e1c r\u1ed1i lo\u1ea1n do suy gi\u1ea3m thanh th\u1ea3i surfactant, v\u00ed d\u1ee5 xu\u1ea5t hi\u1ec7n trong t\u1eafc ngh\u1ebdn m\u00f4i tr\u01b0\u1eddng ph\u1ebf nang, \u0111\u1ea1i th\u1ef1c b\u00e0o, suy gi\u1ea3m ch\u1ee9c n\u0103ng ho\u1eb7c r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a surfactant. Vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh l\u00e0 h\u1eadu qu\u1ea3 do h\u00edt ph\u1ea3i d\u1ea7u c\u00f3 ngu\u1ed3n g\u1ed1c t\u1eeb \u0111\u1ed9ng v\u1eadt, kho\u00e1ng ch\u1ea5t ho\u1eb7c rau c\u1ee7. \u0110\u00e2y l\u00e0 m\u1ed9t trong nh\u1eefng r\u1ed1i lo\u1ea1n l\u00e0m t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i do h\u00edt ph\u1ea3i c\u00e1c ch\u1ea5t trong d\u1ea1 d\u00e0y ho\u1eb7c ngo\u1ea1i sinh. Vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh do h\u00edt ph\u1ea3i c\u00e1c ch\u1ea5t nh\u01b0 s\u00e1p d\u1ea7u kho\u00e1ng (petroleum jelly), d\u1ea7u kho\u00e1ng, d\u1ea7u th\u1ef1c v\u1eadt, d\u00f9ng qu\u00e1 nhi\u1ec1u son m\u00f4i v\u00e0 ngh\u1ec1 nghi\u1ec7p ti\u1ebfp x\u00fac v\u1edbi paraffin ho\u1eb7c c\u00e1c ch\u1ea5t d\u1ea7u kh\u00e1c, nh\u01b0 phun s\u01a1n v\u00e0 c\u00e1c ch\u1ea5t b\u00f4i tr\u01a1n m\u00e1y m\u00f3c. Khi u\u1ed1ng d\u1ea7u kho\u00e1ng, c\u00e1c \u0111\u1eb7c t\u00ednh l\u00fd sinh c\u1ee7a n\u00f3 cho ph\u00e9p t\u00edch t\u1ee5 trong l\u1edbp tr\u00ean d\u1ecbch d\u1ea1 d\u00e0y, \u0111\u00e2y l\u00e0 \u0111\u1eb7c \u0111i\u1ec3m l\u00e0m t\u0103ng nguy c\u01a1 h\u00edt ph\u1ea3i d\u1ea7u kho\u00e1ng tr\u00ean b\u1ec7nh nh\u00e2n tr\u00e0o ng\u01b0\u1ee3c d\u1ea1 d\u00e0y th\u1ef1c qu\u1ea3n (GERD).<\/p>\n
Nhi\u1ec1u ch\u1ea5t ch\u1ee9a d\u1ea7u, bao g\u1ed3m c\u00e1c thu\u1ed1c nhu\u1eadn tr\u00e0ng d\u1ea7u kho\u00e1ng, th\u01b0\u1eddng \u0111\u01b0\u1ee3c b\u00e1n m\u00e0 kh\u00f4ng c\u00f3 th\u00f4ng tin v\u1ec1 t\u00e1c d\u1ee5ng ph\u1ee5 c\u00f3 th\u1ec3 x\u1ea3y ra. Ngo\u00e0i ra, c\u00e1c h\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng v\u1edbi nh\u1eefng lo\u1ea1i d\u1ea7u kho\u00e1ng kh\u00f4ng k\u00ea \u0111\u01a1n th\u01b0\u1eddng khuy\u1ebfn kh\u00edch d\u00f9ng tr\u01b0\u1edbc khi \u0111i ng\u1ee7, \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 l\u00e0m b\u1ec7nh nh\u00e2n b\u1ecb r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ef1c qu\u1ea3n hay nu\u1ed1t do \u0111\u00f3 l\u00e0m t\u0103ng nguy c\u01a1 vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh. M\u1ed9t khi h\u00edt ph\u1ea3i, c\u00e1c ch\u1ea5t n\u00e0y g\u00e2y ra ph\u1ea3n \u1ee9ng ngo\u1ea1i lai m\u1ea1n t\u00ednh do \u0111\u00f3 c\u00e1c \u0111\u1ea1i th\u1ef1c b\u00e0o ph\u1ebf nang th\u1ef1c b\u00e0o lipid nh\u01b0ng kh\u00f4ng th\u1ec3 chuy\u1ec3n h\u00f3a ch\u00fang. Sau khi c\u00e1c \u0111\u1ea1i th\u1ef1c b\u00e0o ch\u1ebft, l\u00e0m gi\u1ea3i ph\u00f3ng lipid, ghi nh\u1edb m\u00e3i trong chu k\u1ef3 chuy\u1ec3n h\u00f3a. Hi\u1ec7n t\u01b0\u1ee3ng sinh l\u00fd n\u00e0y c\u00f3 th\u1ec3 k\u00edch th\u00edch ph\u1ea3n \u1ee9ng u h\u1ea1t, vi\u00eam m\u1ea1n t\u00ednh v\u00e0 th\u1eadm ch\u00ed x\u01a1 h\u00f3a.<\/p>\n
B\u1ec7nh nh\u00e2n vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh c\u00f3 th\u1ec3 kh\u00f4ng bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng ho\u1eb7c hi\u1ec7n di\u1ec7n v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u, nh\u01b0 s\u1ed1t, kh\u00f3 th\u1edf, ho v\u00e0 s\u1ee5t c\u00e2n. X\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng ph\u1ed5i cho th\u1ea5y b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn hay h\u1ea1n ch\u1ebf. Tri\u1ec7u ch\u1ee9ng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u khi\u1ebfn ch\u1ea9n \u0111o\u00e1n g\u1eb7p nhi\u1ec1u kh\u00f3 kh\u0103n v\u00e0 tr\u00ec ho\u00e3n. Vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh th\u01b0\u1eddng g\u1eb7p trong t\u1ea5t c\u1ea3 c\u00e1c nh\u00f3m tu\u1ed5i c\u00f3 xu h\u01b0\u1edbng h\u00edt ph\u1ea3i, do GERD, b\u1ea5t th\u01b0\u1eddng gi\u1ea3i ph\u1eabu ho\u1eb7c b\u1ec7nh th\u1ea7n kinh. Ngo\u00e0i ra, b\u1ec7nh nh\u00e2n vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh nghi ng\u1edd do nhi\u1ec5m vi khu\u1ea9n v\u00e0 vi khu\u1ea9n lao kh\u00f4ng \u0111i\u1ec3n h\u00ecnh.<\/p>\n
Khai th\u00e1c b\u1ec7nh s\u1eed k\u1ef9 c\u00e0ng gi\u00fap x\u00e1c \u0111\u1ecbnh ngu\u1ed3n lipid h\u00edt ph\u1ea3i.<\/p>\n
Tr\u00ean x\u00e9t nghi\u1ec7m h\u00ecnh \u1ea3nh h\u1ecdc, vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n k\u00ednh m\u1edd ho\u1eb7c \u0111\u00e1m m\u1edd \u0111\u00f4ng \u0111\u1eb7c trong th\u00f9y d\u01b0\u1edbi ph\u1ed5i. C\u00e1c v\u00f9ng gi\u1ea3m \u0111\u1eadm \u0111\u1ed9 (-150 \u0111\u1ebfn -30 \u0111\u01a1n v\u1ecb Hounsfield) trong \u0111\u00e1m m\u1edd \u0111\u00f4ng \u0111\u1eb7c, th\u1ea5y tr\u00ean b\u1ec7nh nh\u00e2n n\u00e0y, g\u1ee3i \u00fd nh\u01b0ng kh\u00f4ng ph\u1ea3i ch\u1ea9n \u0111o\u00e1n vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh v\u00e0 kh\u00f4ng ph\u1ea3i l\u00fac n\u00e0o c\u0169ng xu\u1ea5t hi\u1ec7n. B\u1ec7nh nh\u00e2n c\u0169ng xu\u1ea5t hi\u1ec7n c\u00e1c n\u1ed1t v\u00e0 ph\u00ec \u0111\u1ea1i h\u1ea1ch b\u1ea1ch huy\u1ebft, c\u00f3 th\u1ec3 gi\u1ed1ng ung th\u01b0. H\u00ecnh k\u00ednh m\u1edd v\u1edbi d\u00e0y v\u00e1ch li\u00ean th\u00f9y (h\u00ecnh l\u00e1t \u0111\u00e1) c\u0169ng \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 c\u00f3 li\u00ean quan vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh, m\u1eb7c d\u00f9 hi\u1ec7n t\u01b0\u1ee3ng n\u00e0y kh\u00f4ng \u0111\u1eb7c hi\u1ec7u. C\u00e1c bi\u1ec3u hi\u1ec7n tr\u00ean h\u00ecnh Xquang ng\u1ef1c c\u1ee7a vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh th\u01b0\u1eddng dai d\u1eb3ng th\u1eadm ch\u00ed n\u1ebfu kh\u00f4ng c\u00f2n ti\u1ebfp x\u00fac v\u1edbi ngu\u1ed3n lipid.<\/p>\n
BAL \u0111\u01b0\u1ee3c l\u00e0m \u0111\u1ec3 lo\u1ea1i tr\u1eeb nhi\u1ec5m tr\u00f9ng v\u00e0 ung th\u01b0. D\u1ecbch BAL l\u1ea5y t\u1eeb b\u1ec7nh nh\u00e2n vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh c\u00f3 th\u1ec3 m\u00e0u tr\u1eafng \u0111\u1ee5c ho\u1eb7c nh\u1eddn nh\u01b0ng \u0111\u00f4i khi thi\u1ebfu \u0111\u1eb7c t\u00ednh n\u00e0y. X\u00e9t nghi\u1ec7m t\u1ebf b\u00e0o h\u1ecdc th\u00ec th\u1ea5y xu\u1ea5t hi\u1ec7n b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh, t\u1ebf b\u00e0o lympho, b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n \u01b0a acid ho\u1eb7c h\u1ed7n h\u1ee3p c\u00e1c t\u1ebf b\u00e0o vi\u00eam. C\u00e1c kh\u00f4ng b\u00e0o t\u1ebf b\u00e0o ch\u1ea5t trong \u0111\u1ea1i th\u1ef1c b\u00e0o th\u01b0\u1eddng l\u1edbn. M\u1eb7c d\u00f9 nhu\u1ed9m O m\u00e0u \u0111\u1ecf d\u1ea7u gi\u00fap ph\u00e1t hi\u1ec7n lipid ngo\u1ea1i sinh trong m\u1eabu BAL tr\u00ean b\u1ec7nh nh\u00e2n vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh, c\u00e1c b\u1eb1ng ch\u1ee9ng n\u00e0y kh\u00f4ng \u0111\u1eb7c hi\u1ec7u, gi\u1ed1ng nh\u01b0 cho r\u1eb1ng nhu\u1ed9m c\u0169ng c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh lipid ngo\u1ea1i sinh li\u00ean quan \u0111\u1ebfn nhi\u1ec1u r\u1ed1i lo\u1ea1n trong ph\u1ed5i kh\u00e1c. X\u00e9t nghi\u1ec7m m\u00f4 h\u1ecdc, \u0111\u1ea1i th\u1ef1c b\u00e0o ch\u1ee9a nhi\u1ec1u lipid k\u00e8m theo c\u00e1c b\u1eb1ng ch\u1ee9ng vi\u00eam m\u1ea1n t\u00ednh, nh\u01b0 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a m\u00f4 b\u00e0o (histiocyte), t\u1ebf b\u00e0o kh\u1ed5ng l\u1ed3, c\u00e1c t\u1ebf b\u00e0o vi\u00eam kh\u00e1c v\u00e0 x\u01a1 h\u00f3a trong s\u1ef1 k\u1ebft h\u1ee3p kh\u00e1c nhau c\u1ee7a ch\u00fang. M\u1ed9t m\u1eabu sinh thi\u1ebft xuy\u00ean ph\u1ebf qu\u1ea3n nh\u1ecf c\u00f3 th\u1ec3 ph\u00f9 h\u1ee3p nh\u1eb1m ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh. Tr\u00ean b\u1ec7nh nh\u00e2n n\u00e0y, ph\u1ea3n \u1ee9ng t\u0103ng b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh v\u1edbi nhi\u1ec5m MSSA t\u1ea1i th\u1eddi \u0111i\u1ec3m BAL ban \u0111\u1ea7u c\u00f3 th\u1ec3 gi\u1ea3m \u0111\u1ed9 nh\u1ea1y ph\u00e1t hi\u1ec7n c\u00e1c \u0111\u1eb7c tr\u01b0ng c\u1ee7a vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh. M\u1eabu d\u1ecbch BAL th\u1ee9 hai g\u1ee3i \u00fd cao h\u01a1n vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh, v\u00e0 m\u1eabu sinh thi\u1ebft xuy\u00ean ph\u1ebf qu\u1ea3n mang t\u00ednh ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh, do \u0111\u00f3 gi\u00fap b\u1ec7nh nh\u00e2n kh\u00f4ng c\u1ea7n th\u1ef1c hi\u1ec7n m\u1ed9t th\u1ee7 thu\u1eadt x\u00e2m l\u1ea5n h\u01a1n n\u1eefa.<\/p>\n
\u0110i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh t\u1eadp trung ng\u0103n ch\u1eb7n ti\u1ebfp x\u00fac v\u1edbi lipid. B\u1ec7nh nh\u00e2n n\u00e0y l\u00e2m s\u00e0ng \u0111\u00e3 c\u1ea3i thi\u1ec7n sau khi ng\u01b0ng s\u1eed d\u1ee5ng d\u1ea7u kho\u00e1ng v\u00e0 son m\u00f4i, m\u1eb7c d\u00f9 nhi\u1ec1u b\u1ea5t th\u01b0\u1eddng tr\u00ean Xquang ng\u1ef1c v\u1eabn k\u00e9o d\u00e0i. Trong m\u1ed9t lo\u1ea1t b\u1ec7nh nh\u00e2n v\u1edbi ch\u1ea9n \u0111o\u00e1n t\u01b0\u01a1ng t\u1ef1 m\u00e0 \u0111\u00e3 lo\u1ea1i b\u1ecf c\u00e1c y\u1ebfu t\u1ed1 ti\u1ebfp x\u00fac, tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng gi\u1ea3m t\u1eeb 25-46% b\u1ec7nh nh\u00e2n v\u00e0 c\u1ea3i thi\u1ec7n h\u00ecnh \u1ea3nh Xquang ng\u1ef1c t\u1eeb 33-43%. C\u00e1c b\u00e1o c\u00e1o giai tho\u1ea1i m\u00f4 t\u1ea3 c\u1ea3i thi\u1ec7n l\u00e2m s\u00e0ng trong c\u00e1c ca vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh m\u1ee9c \u0111\u1ed9 n\u1eb7ng sau khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng glucocorticoide to\u00e0n th\u00e2n, nh\u01b0ng vai tr\u00f2 c\u1ee7a glucocorticoide trong \u0111i\u1ec1u tr\u1ecb v\u1eabn c\u00f2n b\u00e0n lu\u1eadn. C\u00e1c ca l\u00e2m s\u00e0ng b\u00e1o c\u00e1o c\u0169ng ch\u1ee9ng minh c\u1ea3i thi\u1ec7n sau \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1ch lau r\u1eeda to\u00e0n b\u1ed9 ph\u1ed5i \u0111\u1ec3 lo\u1ea1i b\u1ecf c\u00e1c ch\u1ea5t lipid. Th\u1ef1c hi\u1ec7n ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf kh\u00e1 hi\u1ebfm l\u00e0m khi vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh khu tr\u00fa ho\u1eb7c bi\u1ebfn ch\u1ee9ng do nhi\u1ec5m tr\u00f9ng t\u00e1i di\u1ec5n. \u0110\u00e1p \u1ee9ng ban \u0111\u1ea7u c\u1ee7a b\u1ec7nh nh\u00e2n v\u1edbi kh\u00e1ng sinh sau khi nh\u1eadp vi\u1ec7n ph\u00f9 h\u1ee3p v\u1edbi s\u1ef1 hi\u1ec7n di\u1ec7n b\u1ed9i nhi\u1ec5m t\u1ea1i th\u1eddi \u0111i\u1ec3m \u0111\u00f3.<\/p>\n
B\u1ec7nh nh\u00e2n n\u00e0y b\u1ecb ho v\u00e0 kh\u00f3 h\u1edf t\u00e1i di\u1ec5n c\u00f9ng v\u1edbi h\u00ecnh \u1ea3nh Xquang v\u00e0 m\u00f4 h\u1ecdc ph\u00f9 h\u1ee3p v\u1edbi vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh g\u00e2y ra do s\u1eed d\u1ee5ng k\u00e9o d\u00e0i h\u00e0ng \u0111\u00eam d\u1ea7u kho\u00e1ng nh\u01b0 thu\u1ed1c nhu\u1eadn tr\u00e0ng. Th\u00f3i quen d\u00f9ng d\u1ea7u kho\u00e1ng ngay tr\u01b0\u1edbc khi \u0111i ng\u1ee7 \u1edf t\u01b0 th\u1ebf n\u1eb1m ng\u1eeda v\u00e0 xu\u1ea5t hi\u1ec7n r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng th\u1ef1c qu\u1ea3n, \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh khi l\u00e0m nghi\u1ec7m ph\u00e1p nu\u1ed1t barium, cho th\u1ea5y ph\u1ea7n l\u1edbn nghi\u00eang v\u1ec1 vi\u00eam ph\u1ed5i do h\u00edt d\u1ea7u kho\u00e1ng. Tr\u01b0\u1eddng h\u1ee3p n\u00e0y l\u00e0m n\u1ed5i b\u1eadt nh\u1eefng th\u00e1ch th\u1ee9c trong ch\u1ea9n \u0111o\u00e1n vi\u00eam ph\u1ed5i do lipid ngo\u1ea1i sinh, m\u00e0 kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng \u0111\u1eb7c hi\u1ec7u c\u00f3 th\u1ec3 gi\u1ed1ng v\u1edbi c\u00e1c b\u1ec7nh l\u00fd nhi\u1ec5m tr\u00f9ng kh\u00e1c, b\u1ec7nh t\u0103ng sinh hay vi\u00eam kh\u00e1c.<\/p>\n
T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n\nMarchiori E, Zanetti G, Mano CM, Hochhegger B. Exogenous lipoid pneu[1]monia: clinical and radiological manifes[1]tations. Respir Med 2011; 105: 659-66.<\/li>\n Gondouin A, Manzoni P, Ranfaing E, et al. Exogenous lipid pneumonia: a retro[1]spective multicentre study of 44 cases in France. Eur Respir J 1996; 9: 1463-9.<\/li>\n Betancourt SL, Martinez-Jimenez S, Rossi SE, Truong MT, Carrillo J, Erasmus JJ. Lipoid pneumonia: spectrum of clini[1]cal and radiologic manifestations. AJR Am J Roentgenol 2010; 194: 103-9.<\/li>\n Guo M, Liu J, Jiang B. Exogenous lipid pneumonia in old people caused by aspiration: two case reports and literature review. Respir Med Case Rep 2019; 27: 100850.<\/li>\n Sung S, Tazelaar HD, Crapanzano JP, Nassar A, Saqi A. Adult exogenous lipoid pneumonia: a rare and underrecognized entity in cytology \u2014 a case series. Cyto[1]journal 2018; 15: 17.<\/li>\n Hadda V, Khilnani GC. Lipoid pneu[1]monia: an overview. Expert Rev Respir Med 2010; 4: 799-807.<\/li>\n Samhouri BF, Tandon YK, Hartman TE, et al. Presenting clinicoradiologic fea[1]tures, causes, and clinical course of exogenous lipoid pneumonia in adults. Chest 2021; 160: 624-32.<\/li>\n Cozzi D, Bindi A, Cavigli E, et al. Exogenous lipoid pneumonia: when radiolo[1]gist makes the difference. Radiol Med 2021; 126: 22-8.<\/li>\n Laurent F, Philippe JC, Vergier B, et al. Exogenous lipoid pneumonia: HRCT, MR, and pathologic findings. Eur Radiol 1999; 9: 1190-6.<\/li>\n Baron SE, Haramati LB, Rivera VT. Radiological and clinical findings in acute and chronic exogenous lipoid pneumonia. J Thorac Imaging 2003; 18: 217-24.<\/li>\n Kilaru H, Prasad S, Radha S, Nallagonda R, Kilaru SC, Nandury EC. Nasal application of petrolatum ointment \u2014 a silent cause of exogenous lipoid pneumo[1]nia: successfully treated with predniso[1]lone. Respir Med Case Rep 2017; 22: 98- 100.<\/li>\n Shang L, Gu X, Du S, Wang Y, Cao B, Wang C. The efficacy and safety of thera[1]peutic lung lavage for exogenous lipoid pneumonia: a systematic review. Clin Respir J 2021; 15: 134-46.<\/li>\n Chang HY, Chen CW, Chen CY, et al. Successful treatment of diffuse lipoid pneumonitis with whole lung lavage. Thorax 1993; 48: 947-8.<\/li>\n Lee AS, Lee JS, He Z, Ryu JH. Reflux[1]aspiration in chronic lung disease. Ann Am Thorac Soc 2020; 17: 15.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"Hannah X. Chen, M.D., Ph.D., Manuela Cernadas, M.D., Sara O. Vargas, M.D., Bruce D. Levy, M.D., and Joseph Loscalzo, M.D. D\u1ecbch: B\u00e1c s\u0129. Hu\u1ef3nh Ph\u1ea1m Ho\u00e0ng Nam In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information by sharing relevant background […]\n","protected":false},"author":1,"featured_media":34429,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-34339","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/34339","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=34339"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/34339\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/34429"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=34339"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=34339"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=34339"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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