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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

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

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  1. A 67-yr-old woman with dyspnea and right pleuritic chest pain • Nonsmoker • 1 주 전; cough,sputum, sudden onset dyspnes, Rt. Pleuritic chest pain으로 local방문 chest X-RAY 상 Rt. lung에 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 40,000으로 감소 * thoracentesis 결과 AFB(-) G(+) cocci  initial cefotaxime+ icefacin 사용 후 2일 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

  2. A large soft tissue density in right middle and lower lung zones 19901005 19901005 19901005 19901005

  3. Multilobal mass-like consolidation in right and left lungs

  4. GUN biopsy: Necrotizing inflammation infarction

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

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