作者报道了一例伴有胸膜腔积液、肺大片纤维变性的矽肺患者。患者为70岁男性,轻度千咳和劳累后呼吸困难30年,3个月前病情开始加重,但无发热和体重减少。因疑诊肺结核曾用异烟肼、利福平和吡嗪酰胺正规治疗3年。既往职业为矿工,有大量粉尘接触史。查体发现正侧面有胸腔积液体征X线胸片显示肺下有胸腔积液,双肺上野有大片纤维化阴影。休息时动脉血气分析正常。2次结核菌素试验阴性。6次痰培养结核杆菌和霉菌均为阴性,未检出游离的石棉小体。支气管镜检查显示粘膜弥漫充血和水肿。支气管肺泡灌洗液经涂片和培养结核杆菌、真菌及石棉小体均为阴性。经支气管行肺活组织检查显示间质组织巨噬细胞、单核细胞以及与碳颗粒混合形成的炎性浸润。数个切面未发现含铁小体。偏振光检查的双折射粒子与矽肺所 The authors reported an example of silicosis in patients with pleural effusion and extensive lung fibrosis. The patient was 70 years old with mild cough and 30 years of breathing difficulty after exertion. The condition began to aggravate three months earlier without any fever or weight loss. Due to suspected tuberculosis was used isoniazid, rifampicin and pyrazinamide formal treatment for 3 years. Previous job as a miner, a large number of dust exposure history. Physical examination found positive pleural effusion signs X-ray showed pleural effusion under the lungs, lungs have a large area of ​​bilateral fibrosis shadow. Arterial blood gas analysis at rest was normal. 2 tuberculin test negative. Six sputum cultures of Mycobacterium tuberculosis and mold were negative and no asbestos bodies were detected. Bronchoscopy showed mucosal congestion and edema. Bronchoalveolar lavage fluid smear and culture of Mycobacterium tuberculosis, fungi and asbestos bodies were negative. Transbronchial lung biopsy revealed interstitial tissue macrophages, monocytes, and inflammatory infiltrates that were mixed with carbon particles. Several sections did not find ferrous bodies. Polarized inspection of birefringent particles and silicosis