Morningreport.pptVIP

History 79 year old white male who came to the ER after a fall also had one week history of weakness, dry cough and chest congestion without any fever or night sweats. He is a non-smoker and non-alcoholic.. PHYSICAL EXAMINATION: On physical exam: he was hemodynamically stable and the only significant finding on the physical exam was bronchial breathing on the left lower lobe DIAGNOSTIC STUDIES:  WBC 10.4, Hb 8.4,Hct 27.9,MCV 91, plt 196. Na133, K 4.4, chloride 102, bicarb of 22, BUN of 85, creatinine 1.7 , glucose 170, calcium 9.1. CXR new lung nodule at the right base and infiltrate at the left mid lung level CT Chest Diffuse interstitial and alveolar opacities throughout both lungs, likely a combination of acute and chronic lung disease with small pleural effusions. Fairly suspicious-appearing nodule right middle lobe 18 mm in diameter solitary pulmonary nodule Malignant Etiology: .Adenocarcinoma 50% .Squamus cell carcinoma 25-20% .metastatic 25% if Pt already has extrapulm ca (colon ,breast, kidney, testicular, melanoma) .large cell carcinoma and other lung Ca, Malignant lymphoma and carcinoid 5%. solitary pulmonary nodule Benign etiology .Infectious Granulomas 80% (Endemic fungi e.g., histoplasmosis, coccidioidomycosis and mycobacteria are most common) .Hematoma 10 % Pathology of the patient lung nodule Revealed poorly differentiated non small cell lung neoplasm with focal necrosis. Results of immunohistochemistry were consistent with melanoma. After this histological diagnosis the patient was extensively examined to locate the primary tumor but the attempts were unsuccessful. Patient had a PET scan which showed metastasis to the liver. Patient was classified as stage IV. Metastatic melanoma Nodal or visceral metastasis may be the first presentation of melanoma . This occurs in less than 2% of all melanoma cases and less than 5% of all patients with metastatic melanoma. These patients should have a thorough sk