Case  01

A. Chief complaint

Cough with white sputum for more than one month.

B. Present illness

This 62 y/o male patient is a case of hypertension with regular medical control. He suffered from cough with white sputum for more than one month. The associated symptom/sign were dyspnea, fever, chillness and body weight loss. He visited the 婦幼hospital for help on 93-3-15 and then he was transferred to our hospital under the impression of pneumonia, R/O TB, R/O malignancy according to a serial examination (CXR on 93-3-15 and Chest CT on 93-3-16).

He was admitted at our chest surgery department (93-3-17) where the thoracocentesis (93-3-17) and pleural biopsy (93-3-23) were performed for diagnosis.

The Lab. Data (93-3-17): WBC:9.09X103/ul, RBC:3.66X106/ul, Hgb:10.7g/dl, PLT: 474X103/ul, CRP:201.1/ul, sputum stain: acid fast stain: (-), pleural effusion: acid fast stain: (-), cell counting: 360x11/9 /mm, PMN/mono: 5% / 95%, no growth on aerobic/anaerobic bacteria culture.

The image exam results are as 【 Fig. C01-1】,【 Fig. C01-3】 and 【 Fig. C01-4】.

C. Problems:

1.  Differential diagnosis between pneumonia, TB, and malignancy.

2.  The pathologic diagnosis (according to the slide).

3.  The treatment protocol.

D. Others:





【 Fig. C01-1】The CXR on 93-3-15


【 Fig. C01-3,4】The Chest CT on 93-3-16