胸部x光判讀cxr reading 20090924

Case 1

Gender and age: 25 Gender and age: 25 女性女性 Occupation: Occupation: 學生學生 Past history: Pityriasis rosea Past history: Pityriasis rosea Personal history: Smoking (-) Personal history: Smoking (-) Chief complaint: progressive dyspnea for two Chief complaint: progressive dyspnea for two

monthsmonths

2009/9/12 CT scan

1. a large tumor in the superior mediastinum, about 12*6cm. There is no calcification or cystic content. DDx: germ cell tumor, thymoma, thyroid tumor, teratoma, or lymphoma.

2. high density pericardial effusion, r/o tumor involvement.

3. enlarged lymph nodes in the left scalene and supraclavicular regions.

9/14 chest echo-guided Tru-cut biopsy

MEDIASTINUM, ANTERIOR, CORE NEEDLE BIOPSY

----PRIMARY MEDIASTINAL LARGE B-CELL LYMPHOMA

Final diagnosis

1. NHL(primary mediastinal B-cell lymphoma) stageIIAX, 12*6cm, with left neck LAP. pericardial invasion was also found.

Case 2

Gender and age: 76 Gender and age: 76 女性女性 Occupation: Occupation: 無無 Past history: .ESRD regular H/D, Hypertnesion Past history: .ESRD regular H/D, Hypertnesion Personal history: Smoking (-) Personal history: Smoking (-) Chief complaint: hemoptysis 6 days ago. Chief complaint: hemoptysis 6 days ago.

Final diagnosis Aortic arch aneurysm

Case 3

Gender and age: 19 Gender and age: 19 女性女性 Occupation: Occupation: 學生 學生 Past history: p-ANCA vasculitis, End stage Past history: p-ANCA vasculitis, End stage

renal disease, due to focal segmental renal disease, due to focal segmental glomerulosclerosisglomerulosclerosis

Personal history: Smoking (-) Personal history: Smoking (-) Chief complaint: Dyspnea for 2 days. Chief complaint: Dyspnea for 2 days.

2009/08/21 CT scan

Diffuse patchy consolidation/ground-glass attenuation and pulmonary nodules of varying sizes (5 mm to 10 cm) in nonsegmental distribution without zonal predominance, favor intraalveolar pulmonary hemorrhage.

After pulse therapy 2009/08/26 CXR

2009/08/27 bronchoscopy

Broncheoalveolar lavage IRON STAIN(+).

Final diagnosis

Pulmonary hemorrhage, due to 2 P-ANCA vasculitis, suspected microscopic

polyangitis

Case 4

Gender and age: 59 Gender and age: 59 女性女性 Occupation: Occupation: 自由業 自由業 Past history: hypertensionPast history: hypertension Personal history: Smoking (-) Personal history: Smoking (-) Chief complaint: progressive dyspnea and Chief complaint: progressive dyspnea and

bilateral limbs edema for 3 weeksbilateral limbs edema for 3 weeks

After pigtail drainage

2009/9/8 CT scan

Huge left breast cancer with chest wall invasion, T4cN3M1.

Mild pericardial effusion. Pleura: Right pleural effusion. Left

hydropneumothorax with pleuritis and a drain tube insertion.

Pleural effusion cytology

RESULT: SUGGESTIVE OF MALIGNANCY 採檢品質 : ADEQUATE SPECIMEN

COMMENT: ADENOCARCINOMA IS FAVORED.

Pathology

BREAST, LEFT, CORE NEEDLE BIOPSY ----MIXED MUCINOUS CARCINOMA AND

INVASIVE DUCTAL CARCINOMA

Final diagnosis

Huge left breast cancer with chest wall invasion and malignant pleural effusion,

Case 5

Gender and age: 21 Gender and age: 21 男性男性 Occupation: Occupation: 自由業自由業 種族種族 : Korean: Korean 婚姻婚姻 : single: single 旅遊史旅遊史 :In Thailand 2 days ago:In Thailand 2 days ago Past history: unknownPast history: unknown Personal history: smoking - Personal history: smoking - Chief complaint: Vomiting, conscious change Chief complaint: Vomiting, conscious change

for one dayfor one day

2009/08/26

CXR and CT scan 3 days later

2009/08/26 CT scan

Bilateral lower lobe consolidation with bilateral pleural effusion.

After extubation

Final diagnosis

RLL consolidation with pleural effusion, suspect aspiration pneumonia

Heroin body packing caused opioid intoxication complicated with consciousness change, respiratory failure, and shock status, status post endotracheal tube insertion and mechanical ventilation

Thanks for your attention.