肺炎英文版

PneumoniaCaseDiscussionXuChangqingAddress:HangzhouCity,WenzhouRoadNo.16Email：[e-mail]2019/10/81Theconditionofthepatient1,YuJinyu,male,64yearsold,2,5monthsago,thepatientstartedcoughingwithoutacause,coughingwhitesputum.Moreseverely:feverwithatemperatureof38℃.Inthelocalcommunityhospitalhewastreatedfor2dayswithoutanyimprovement.Sohecametoourhospitaltobeadmittedwithpulmonaryinfection.2019/10/82Theconditionofthepatient3,ExaminationofpulmonaryCT:Doublepneumonialesions,forantiinfection,stopcoughandphlegmandothertreatments.Thetemperaturedroppedgraduallyandtheconditionimproved.4,Thepatientwascarelessastoinhalefoodonemonthbeforehand,thenthepatientbegantocough,sputum,andhavefever.Afterbeinghospitalized,feedingthroughanasogastrictube,antiinfection,andphlegmtreatment.Theconditionimproved.Multiplehospitalizations.2019/10/83Theconditionofthepatient4,1dayago,thepatient'sconditionworsened.Hewasadmittedtothehospitalforfurthertreatment,quasi“Pneumonia,Parkinson'sdisease,admittedtoourdepartment.HasParkinson'sdiseasehistoryfor5years.2019/10/84TheconditionofthepatientPhysicalexamination:P90/R19/BP119/72mHgT36.6.Clearconsciousness,bedrest,nasalfeeding.Skinandsclerawithoutyellowdye,nolipscyanosis,asoftandnotswollensuperficiallymphnodeofneck,nojugularveinenlargement,tracheae,nochestdeformity,theintercostalspacewithoutbroadening,doublelungbreathingsymmetry,nochange,fremituswithoutchange,bilateralpercussionsound,twopulmonaryrespirationcrudeandobviously,noralesorrhonchi;hearthasnoenlargement,heartrate90,thelawisneat;theabdomenissoft,completeabdomentenderness,noreboundtenderness,belowliverlienalcostalregionwithoutpalpablemass,renalareawithoutpercussionpain;lowerextremitiesedema,neurologicalexamination:limbsadverseevents,activitiesjointdegreeislimited,muscletensionincreased,strengthcannotcheck.2019/10/85Theconditionofthepatient2013-11-27chestCTscan:comparisonofthefrontsheet(2013-10-28)twopulmonaryinfectionswithbilateralpleuraleffusionwasimproved;hintatthethoracicinletendotrachealnodularprotrusion.2019/10/86NormalChestCTScan2019/10/87Lung:therightlungleftlungtwoleafclover.Thepulmonaryfissures(obliquefissure,horizontalfissure)boundary,appearedaslowdensitypancivascularareaorlinearhighdensityPulmonarysegments:therightlungleftlungisdividedintotensegments,eightsegments.SegmentalbronchusTubeinthelung,pulmonaryarterysegmentcenter.Alveolar:filledwithgas,sothelungshowedlowdensityshadow.Bronchus:fillinggas,thetubularlow-densitygasasthecharacteristicsof.Pulmonaryvascular:pulmonaryintravascularfillingblood,showedhighdensity.ChestCTscanofthepatient2013-11-262014-01-022019/10/88Recurrentcough,feverThroughavarietyofantimicrobialtreatmentThefirst,second,threelineantibioticsPenicillin,Cephalosporins[sefəloʊs'pɔ:rɪnz],Fluoroquinolones[flʊəroʊkwaɪnə'loʊnz],Carbapenems[kɑ:bæ'penemz]etc.Thereare4possibilities1,Thediagnosisisnotclear2,Theolder3,Abnormalimmunefunctions4,Combinedwithvariousunderlyingdiseases2019/10/89ThoughtWecansee,thepatient'sconditionhasimproved,butthereisnoobviousimprovementinimaging,Thisischaracteristicofaspirationpneumonia,pulmonarylesionsdifficulttoabsorb,Patientswithlowimmunity,easyrecurrenceofpneumoniaSo,thepatientswithrecurrentpneumonia,sohehastostayinthehospital2019/10/810ThoughtSymptomsofbacterialpneumoniaislarger,canbelightweight,determinedbythepathogenandhoststate.Thecommonsymptomswerecough,expectoration,ortheoriginalrespiratorysymptomsincreased,andtheemergenceofpurulentsputumorsputumwithblood,withorwithoutchestpain.2019/10/811Pneumoniadiseaserangecanhavedifficultybreathing,respiratorydistress.Mostofthepatientshavefever.Earlysignshavenoobviousabnormity,seriouspersoncanhavehighrespiratoryrate,flaringofnares,cyanosis.2019/10/812ThoughtClinicalmanifestationPulmonaryconsolidationwithtypicalsigns,suchasenhanced,fremituspercussiondullnessandbronchialbreathsounds,canalsobeheardandrales.Pleuraleffusion,ipsilateralchestpercussiondullness,diminishedbreathsounds.2019/10/813Differentialdiagnosis1,PulmonarytuberculosisManysymptomsofsystemicpoisoning,afternoonfever,nightsweats,fatigue,weakness,weightloss,insomnia,heartpalpitationsandothersymptoms.X-rayvisiblelesionsintheapicalorsupraclavicular,unevendensity,dissipatedslowly,andcanformacavityorintrapulmonaryspread.Mycobacteriumtuberculosiscanbefoundinthesputum.Theconventionalantibiotictherapy.2019/10/814Differentialdiagnosis2,LungcancerOftenhasahistoryofsmoking.Hasacough,sputum,bloodysputumsymptoms.Whitebloodcellcountisnothigh,iffoundthatthecancercellsinsputumcanbeconfirmed.Beaccompaniedwithobstructivepneumonia,afterantibiotictreatmentinflammationisnoteasytodissipate,orvisiblehilarlymphnodeenlargement,sometimesappearsatelectasis.ItisnecessarytodotheCT,MRI,fiberopticbronchoscopyandsputumcytologicexamination.2019/10/815Differentialdiagnosis3,AcutepulmonaryabscessTheearlyclinicalmanifestationissimilar.Asthediseaseprogresses,expectorationofpurulentfoulsputumforlungabscess.TheX-rayfilmsshowedtheabscesscavityandfluidlevel.2019/10/816Differentialdiagnosis4,PulmonarythromboembolismManyriskfactors