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Case Report29th Oct 2014

Resident on duty : dr.Desdiani, dr. Ditriana,dr.Elizabeth

 Superisor : dr. !oni ! S Sp." # $ %

&or'in( Dia(nose: Ri(ht Localized Hydropneumothorax d/tPersumtive MDR TB

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"atient)s *dentity

• !a+e : r. -

• (e : 4/ years old

• Se : ale

•  ob : Drier

• Ethnic : aanese

• Reli(ion : *sla+

• ddress : edan• &ei(ht : 30 '(

• ei(ht: 150 c+

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*S6OR7 O8 "RESE!6*! *!ESSMale, 43 years old, smoker, (IB: moderate). History of ATT (+) on Septemer

!"#3,$ate%ory I from &'lmonolo%ist ased on te $lini$al, sp't'm and radiolo%i$findin%s, $ons'med for # year and stopped y imself. History of iaeti$

Mellit's for * years, and te patient $ons'med %lienklamid irre%'llary. In

$toer !"#4, patient ad een admitted to Hai -eneral Hospital for 3 eeks

e$a'se of sortness of reat and ad tora/ drain insertion for * days.

Sortness of reat (+) sin$e 3 years a%o and orsen in # mont it li%t

a$ti0ities.(MM12 I).2est pain as een o$$'rred in # mont,espe$ially on te

ri%t emitora/ and orsen it $o'% or d'rin% deep reat, referred pain(+).

oss of ody ei%t(+) 5 #" k% in 3 monts. 6e0er(7), istory of fe0er (+) sin$e #

mont.2o'%(+) as een $omplained for # mont it %reenis sp't'm. Bloody $o'%

(7), istory of loody $o'% (+), ! monts a%o, streak loody sp't'm.

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;*6 S*!

eel o< : lert=onsciousness

-" : 110>?0 ++(

eart Rate : 120 > i re(uler RR : 2@ > i,

 6e+p : /5,3A = aila

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  Physical Examination

• Head : eformity (7).

• 8yes9ears9ose9ip: p'pil isokor, s$leral i$ter's (797), anemia(797), ptosis (797) , oral

$andidiasis (7)• e$k :Tyroid -land enlar%ement (7), ymp node enlar%ement (7),

;'%'lar ein &ress're 17! $m H!

• Tora/

Inspection

Palpation

Percussion

Auscultation

  nterior

Sy++etry 8us

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• bdo+en

  ier > Spleen > $idney not palpable

• E'stre+itypper : sianosis #B%,"O

#B%,=lubin(

n(er #B%, nicotinestainin( #B%, tattoo#B%

  oer : oede+ #B%

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LABORATORY FINDIN! IN ADA" "ALI# $O!PITAL

 HGB 10.00 (F 12,5 G 1?.4

WBC 1@./? 10/

>++H 4,3B11,0

RBC /,@1 105>++H 4,20B4,@?

e+ato'rit 29,?0 F 4/ G 49

"6  /@2 10H>++H 130B430

!eutrol ??.4 10H>I 2,?B5,3i+I 1,3B/,?

onosit 12,@ 10H>I 0,2B0,4

Eosinol 0,?0 10H>I 0B0,10

-asol 0,/00 10H>I 0B0,1

KGD ad random 120.?0 +(>dl C200

Ureum/Kretinin 19.30> 0.50 +(>d C?1>0,?0B1,20

Na/K/Cl 123>/,9>92 +EJ> 1/3B133>/,5B3,3>95B105

conclusion% Anemia& Leu'ositosis

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LABORATORY FINDIN! IN ADA" "ALI# $O!PITAL

 

Test (alue )nit Normal (aluep ?,420 ?./3B?.43

PCO* /4,5 ++( /@B42

PO* 152,0 ++( @3B100

$CO+ 22,0 ++ol>

**,*-

tCO* 2/,0 ++ol>

./,*0

BE B2,2 ++ol>

,* , 1*

O* !at 99,4 F 93B100

CONCLUSION : full compensate

respiratory alkalosis with hiperoxemia

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Chest 2,ray at A3am "ali' $ospital *45.65.7

Position PA Erect

Patients position 8as symmetric

Inspiration

ai+u+ inspiration• Diaphra(+ cuts the anterior ribs: 3th 

rib

• Diaphra(+ cuts the posterion ribs:

@th rib

Exposure

to

Ront9en

ra3iation

Stron(,

thora etebrae as isible till the

12th eterbrae.

Trachea edialCla:icle sy+etrical, K;) shaped, not

superposition no

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Ri(ht ateral =hest Bray2@>10>2014 at

da+ ali' ospital=onclution :"leural line #L%, air

Muid leel #L%,

abroncoascular inthe loer o< le

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Chest 2,ray at A3am "ali' $ospitalpost aspiration *45.65.7

Position PA Erect

Patients position 8as symmetricInspiratio

n

ai+u+ inspiration

• Diaphra(+ cuts the anterior ribs: 3t

rib

• Diaphra(+ cuts the posterion ribs:

@th ribExposure

to

Ront9en

ra3iation

Stron(,

thora etebrae as isible till the

12th eterbrae.

Trachea edialCla:icle sy+etrical, K;) shaped, not

superposition no

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eneral !ur:ey

 (UPON ADMISSION) 

Sensoriu+ : lert, conscious

-lood "ressure : 110>@0 ++(

eart Rate : 113 > i,# t>

enou(h,re(uler % RR : 25 > i, usin( o< respiratory

+uscle #B% Dispnoe R= (rade *;

 6e+p : /5,5A =

S"O2 :99 F

"ain : #L%, ;S 4 #+ild%

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"hysical Ea+ination

Inspection

Palpation

Percussion

Auscultation

  nterior

Sy++etry 8usB%

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DIFFERENTIAL DIAGNOSIS :1. Massive Haemoptysis

due to 1.Pumo!a"y tu#e"$uosis

  %. susp. MDR a!emia due

#"o!&ie&tasis $'"o!i$(. u!) mi$osis disease

  *. p!eumo!ia

+OR,ING DIAGNOSE:

Massive Haemoptysis due to Pumo!a"y Tu#e"$uosis -a!emia due to $'"o!i$ disease- #"o!&ie&tasis

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MANAGEMENT AT EMERGEN/ ROOM

• No! P'a"ma$oo)y:

Bed Rest Thoracosintesis

• P'a"ma$oo)y

  O !" l/i nasal canule

#$%D &a'L ()* + ( ,tt/i

#n-ection 'e.triaxone ! ,r/ ! h/ iv

#n-ection entamycin 0( m,/ ! h / iv

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Than3

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8or+ula 8iO• "a O : =!4x ()>5"a O astrup x !)?6

  =!4x()>"5>>)*x!)?6  =!4x()> " ?@)!?

  A !!>)**?

"a O : !(* ()>4 x = 9 >

  !(!)4*

"a O astrup A "a O  yan, diin,in3an

"a O  "a O  yan, 1aru

!4=)! A 0=)4=

!!>)**? x  

0 2(3%4(1

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8or+ula 8iO

• "a O A=!4 x 8iO 5"a O astrup x !)?6

=4)0 A =!4 x 8iO 5>>)*x!)?6

 8iO A ()!0