霉菌性动脉瘤破裂以及沙门氏菌感染导致的脓胸课件.pptVIP

Empyema in Mycotic Aneurysm Rupture and Salmonellosis: A case Report 彰化基督教醫院內科 許文瑞 Case Presentation- History and Present illness C.C. fever and abdominal pain 53 y.o. male with history of hypertension and type 2 D.M. presented to the emergency department for bilateral low back pain, fever, and chills for 10days. He visited our GI clinics because of abdominal discomfort and diarrhea 3 days prior to admission. He described the abdominal discomfort as an intermittent colicky pain over the epigastric area. Denied cough, S.O.B. or chest pain. Case Presentation- History and Present illness He smoked cigarette on pack a day for 20 years. He denied any history of foreign travel or use of illegal drugs, or alcohol use. He had not been compliant with taking oral hypoglycemic agents for the past 2 years. He had never taken antihypertensive med. Case Presentation- Physical Examination Patient was a 60 kg obese male in moderate discomfort. B.P. 202/104 mmHg. Pulse: 98/min, Temp 38.6℃. Neck: engorged jugular vein. Chest: bilateral basal crackles. Heart: RHB. No murmur, no gallop. Abd: mild tenderness at epigastric area.nomoactive B.S., no palpable mass or bruit. Back: No CVA tenderness. Ext: no edema, or cynosis. Case Presentation: Initial Lab CBC: WBC 13,600/ul with 86% neutrophils and left shift; Hgb/Hct 12.3g/dl/36.4%; Plt 451,000/ul Serum electrolyte levels (including amylase and lipase) and coagulation studies were normal except for blood glucose 347 mg/dL. EKG: NSR CXR KUB Case Presentation-Lab Pleura echo: LLL consolidation with air bronchogram and little amount of PLE. Diagnostic thoracentesis for left pleural effusion and pleural fluid showed cloudy yellowish with leukocyte count of 33,250/uL, consisting of 98% neutrophils, pH 8.3, glucose 294 m/dL, and LDH 634 mg/L Echocardiogram: minimal amount of pericardial effusion 100ml. normal wall motion, left atrium dilation with a diameter of 42 mm. Case Presentation- Hospital Course The patien