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Title : 75 year-old male w/Incidental finding on routine plain chest radiograph
Date : December 5, 2011
Contributed by

Young Eun Ha, M.D.
Div. of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine

Patient History
Age/Sex 75 year-old / Male
Chief complaint Incidental finding on routine plain chest radiograph
Present illness

A 75 year old man was admitted due to incidental finding on routine plain chest radiograph at outpatient clinic.

Two months before, the patient had developed generalized edema with acute renal failure. With the impression of nephrotic syndrome, he had undergone kidney biopsy, which revealed minimal change disease. He had been started on methylprednisolone 60mg/day and maintained high dose steroid for more than 2 months. Meanwhile, he had been treated for Pseudomonas pneumonia for which antibiotic therapy was adequate with good clinical response. However, follow-up chest plain radiograph at outpatient clinic rather showed increased cavitary lesion. So the patient was admitted for further work-up. He denied any travel history within one year, sick contact, and intake of raw fish, meat or fresh water.

Past medical history

Hypertension for 10 years

Internal carotid artery stenosis for 8 years

Physical examination

GA

 Not so ill-looking appearance

 Alert mentality & well oriented 

HEENT

 Not anemic conjunctivae

 Anicteric sclerae

 Not dehydrated tongue & lips

 No cervical LNE

 PI/PTH (-/-)

 NVE (-/-)

 

CHEST

 Symmetric chest wall expansion

 VBS without rale

 RHB without murmur

 

ABDOMEN

 Soft & flat

 NABS

 Td/RTd (-/-)

 No hepatosplenomegaly

 

BACK & EXT.

 Mutiple bruises

 CVAT (-/-)

 PTPE (-/-)

Initial laboratory findings

WBC  5660/uL (seg 93.1%) Hb 9.0g/dLHematocrit  27.3%,    Platelet  119,000/uL

ESR 109mm/hr ,   CRP 1.59mg/dL

Total bilirubin  0.5mg/dL,   AST/ALT   33/33 U/L,   ALP 132 U/L

BUN  74.9mg/dL,     Creatinine 2.78mg/dL

Radiologic findings


 
Question - ID Case of the Week ( December 5, 2011 )
What is the most probable diagnosis in this patient?
Please send us your answer to the following e-mail address ( nuove@ansorp.org ).
• Name
• Country
• E-mail address
• Answer
The true answer of this case and a brief review will be presented next week.
The names of the persons who gave us a right answer will be also announced.


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