临床病理世讨论会.ppt

臨床病理討論會 小兒科：盧俊維醫師 放射科：吳金珠醫師病理科：蕭正祥醫師 A 10 y/o girl Chief complaint: Chest discomfort, vomiting and dry cough for one day Brief History Growth development: Weight: 22 kg (3rd-10th percentile) Height: 130 cm (25-50th percentile) Development milestone: within normal limit Past history Hand-foot-mouth disease in 1998 Frequent URI and fever during childhood No drug or food allergy Brief History Family history: Her sister had fever and URI recently. Present Illness Fever and bilateral hand arthralgia attack once 1 month ago Chest discomfort and cough since 9/11 afternoon, 2001 Visit LMD and URI was told Vomiting and chest tightness on 9/12 0 AM and 5 AM Present Illness 9/12 morning, visit LMD again, ECG showed arrhythmia Refer to 亞東 hospital Present Illness Findings at 亞東 hospital Clear consciousness, ill-looking, pallor appearance, no cyanosis Irregular heart beat EKG: VPC bigeminy Present Illness Lab. findings at 亞東 hospital WBC 9000/mm3, Hb 13.5 g/dl BUN 11 mg/dl, Cre 0.6 mg/dl GOT 25 U/L, CK 665 U/L, CK-MB 175 U/L Present Illness Echocardiogram at 亞東 hospital Multiple small VSDs, muscular trabecular type, at apex LV dyskinesia, LVEF 60-70% Mild TR, mild MR Present Illness Management at 亞東 hospital Lidocaine iv drip Dopamine 10 mg/kg/min Refer to NTUH (2pm) Physical Examination Physical findings at NTUH Consciousness: lethargic, acute ill-looking T/P/R: 37/140/25 BP 80/46 SaO2 97% HEENT: pale conjunctiva anicteric sclera mild cyanotic lip Physical Examination Neck: jugular venous engorgement Chest: bilateral basal r?les Heart: irregularly irregular beats, distant heart sound no murmur Physical Examination Abdomen: no hepatomegaly hypoactive bowel sound Extremities: freely movable cold and cyanotic poor capillary refilling Initial Lab Data CBC: WBC Hb Hct Plt 8840