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A 67-yr-old woman with dyspnea and right pleuritic chest pain. Nonsmoker 1 주 전 ; cough,sputum, sudden onset dyspnes, Rt. Pleuritic chest pain 으로 local 방문 chest X-RAY 상 Rt. lung 에 hazziness (+) Dyspnea aggravation, chest X-RAY 에서 병변 더욱 악화 , local H 입원 - PowerPoint PPT Presentation
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A 67-yr-old woman with dyspnea and right pleuritic chest pain
• Nonsmoker
• 1 주 전 ; cough,sputum, sudden onset dyspnes, Rt. Pleuritic chest pain 으로 local 방문 chest X-RAY 상 Rt. lung 에 hazziness (+)
• Dyspnea aggravation, chest X-RAY 에서 병변 더욱 악화 , local H 입원– diagnostic thoracentesis; pH 7.339 WBC 4590 (neutro 95%, lymph 5%), protein 4– cytology smear : acute& chronic inflammation– intermittent hemoptysis (+) fever(+)
• 3 일전 ; cbc 상 Platelet 40,000 으로 감소 * thoracentesis 결과 AFB(-) G(+) cocci initial cefotaxime+ icefacin 사용 후 2 일 전부터 meropenem 으로 Change ICU care 중 호전없고 진행하는 양상보여 SMC ER 로 전원됨
– intial V/S 134/71- 104/32- 36.9'C– * ABGA: 7.518-40.0- 53.8- 31.8- 91.0– * lab: wbc 15200-13.3- 54K ( ESR 91, CRP 30.52)– Na-k-cl 131-3.6- 92 NT- proBNP 235
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A large soft tissue density in right middle and lower lung zones
Multilobal mass-like consolidation in right and left lungs
GUN biopsy: Necrotizing inflammation infarction
GUN biopsy: Necrotizing inflammation infarction (septic emboli, septic vasculitis)