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A 67-yr-old woman with dyspnea and right pleuritic c hest pain Nonsmoker 1 주 주 ; cough,sputum, sudden onset dyspnes, Rt. Pleuritic che st pain 주주 local 주주 chest X-RAY 주 Rt. lung 주 hazziness (+) Dyspnea aggravation, chest X-RAY 주주 주주 주주 주주 , local H 주주 diagnostic thoracentesis; pH 7.339 WBC 4590 (neutro 95%, lymph 5%), protein 4 cytology smear : acute& chronic inflammation intermittent hemoptysis (+) fever(+) 3 주주 ; cbc 주 Platelet 40,000 주주 주주 * thoracentesis 주주 AF B(-) G(+) cocci initial cefotaxime+ icefacin 주주 주 2 주 주주주 meropenem 주주 Change ICU care 주 주주주주 주주주주 주주주주 SMC ER 주 주주주 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

A 67-yr-old woman with dyspnea and right pleuritic chest pain

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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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Page 1: A 67-yr-old woman with dyspnea and right pleuritic chest pain

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

Page 2: A 67-yr-old woman with dyspnea and right pleuritic chest pain

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A large soft tissue density in right middle and lower lung zones

Page 3: A 67-yr-old woman with dyspnea and right pleuritic chest pain

Multilobal mass-like consolidation in right and left lungs

Page 4: A 67-yr-old woman with dyspnea and right pleuritic chest pain

GUN biopsy: Necrotizing inflammation infarction

Page 5: A 67-yr-old woman with dyspnea and right pleuritic chest pain

GUN biopsy: Necrotizing inflammation infarction (septic emboli, septic vasculitis)