Chest
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A 51-year-old man presented with chest tightness, exertional dyspnea, and occasional chest pain for 2 years. The patient visited his local hospital initially, and CT scan revealed a ground glass opacity (GGO) located in the right upper lobe (Fig 1A). He was diagnosed as having pulmonary infection and treated with levofloxacin for 12 days. ⋯ Accompanied with an increased D-dimer level (> 10 mg/L; normal range, 0-0.5 mg/L), a diagnosis of pulmonary embolism was made. The patient was treated with warfarin, and his symptom of dyspnea was partially relieved. He came to our hospital for further treatment 4 months later.
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A 23-year-old man presented to the ED with a history of respiratory distress, cough, and fever for 10 days. He was evaluated in the ED, where he received a diagnosis of pulmonary edema, secondary to mitral regurgitation with mitral valve prolapse syndrome. He was treated with antibiotics and diuretics and discharged to home. ⋯ The patient was admitted to the medical ICU. He had no history of arthralgia, myalgia, skin rash, or other signs of autoimmune disease. He denied any history of smoking, work-related or occupational exposures, drug intake, or recent travel.
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A 75-year-old patient with autosomal dominant polycystic kidney disease (ADPKD) and hypertension was admitted to the hospital with abdominal pain secondary to a choledochal cyst resulting in biliary dilation. His hospital course was complicated by pneumonia, encephalopathy, and lower gastrointestinal bleeding (LGIB) that initially did not lead to hemodynamic compromise. To further evaluate the LGIB, a colonoscopy was performed, during which he experienced significant hypotension after being placed in the supine position and given anesthesia. The hypotension required treatment with vasoactive medications, termination of the colonoscopy, and transfer to the medical ICU for invasive hemodynamic monitoring and treatment.
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A 34-year-old man who did not use tobacco complained of hemoptysis with a small volume, severe dry cough, and low-grade fever for 5 months. He denied dyspnea, chest pain, night sweats, or weight loss. Chest CT scanning showed nodules with a cavity in the lower left lung. ⋯ He was prone to spontaneous bruising since childhood with a family history of spontaneous cerebral aneurysm. At 21 years of age, the patient underwent an appendectomy because of a suspected perforation. Also, he experienced cerebral hemorrhage 3 years earlier.