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】.
1. Differential diagnosis between pneumonia, TB, and malignancy.
2. The pathologic diagnosis (according to the slide).
3. The treatment protocol.
【 Fig. C01-1】The CXR on 93-3-15
【 Fig. C01-3,4】The Chest CT on 93-3-16