8/9/2019 Case Report Bahrum Pulmo
1/21
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
8/9/2019 Case Report Bahrum Pulmo
2/21
"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+
8/9/2019 Case Report Bahrum Pulmo
3/21
*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 $o'% (+), ! monts a%o, streak loody sp't'm.
8/9/2019 Case Report Bahrum Pulmo
4/21
;*6 S*!
eel o< : lert=onsciousness
-" : 110>?0 ++(
eart Rate : 120 > i re(uler RR : 2@ > i,
6e+p : /5,3A = aila
8/9/2019 Case Report Bahrum Pulmo
5/21
Physical Examination
• Head : eformity (7).
• 8yes9ears9ose9ip: p'pil isokor, s$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
8/9/2019 Case Report Bahrum Pulmo
6/21
• 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%
8/9/2019 Case Report Bahrum Pulmo
7/21
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
8/9/2019 Case Report Bahrum Pulmo
8/21
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
8/9/2019 Case Report Bahrum Pulmo
9/21
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
8/9/2019 Case Report Bahrum Pulmo
10/21
Ri(ht ateral =hest Bray2@>10>2014 at
da+ ali' ospital=onclution :"leural line #L%, air
Muid leel #L%,
abroncoascular inthe loer o< le
8/9/2019 Case Report Bahrum Pulmo
11/21
Chest 2,ray at A3am "ali' $ospitalpost aspiration *45.65.7
Position PA Erect
Patients position 8as symmetricInspiratio
n
ai+u+ inspiration
• Diaphra(+ cuts the anterior ribs: 3t
rib
• Diaphra(+ cuts the posterion ribs:
@th ribExposure
to
Ront9en
ra3iation
Stron(,
thora etebrae as isible till the
12th eterbrae.
Trachea edialCla:icle sy+etrical, K;) shaped, not
superposition no
8/9/2019 Case Report Bahrum Pulmo
12/21
8/9/2019 Case Report Bahrum Pulmo
13/21
eneral !ur:ey
(UPON ADMISSION)
Sensoriu+ : lert, conscious
-lood "ressure : 110>@0 ++(
eart Rate : 113 > i,# t>
enou(h,re(uler % RR : 25 > i, usin( o< respiratory
+uscle #B% Dispnoe R= (rade *;
6e+p : /5,5A =
S"O2 :99 F
"ain : #L%, ;S 4 #+ild%
8/9/2019 Case Report Bahrum Pulmo
14/21
"hysical Ea+ination
Inspection
Palpation
Percussion
Auscultation
nterior
Sy++etry 8usB%
8/9/2019 Case Report Bahrum Pulmo
15/21
DIFFERENTIAL DIAGNOSIS :1. Massive Haemoptysis
due to 1.Pumo!a"y tu#e"$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
8/9/2019 Case Report Bahrum Pulmo
16/21
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
8/9/2019 Case Report Bahrum Pulmo
17/21
8/9/2019 Case Report Bahrum Pulmo
18/21
8/9/2019 Case Report Bahrum Pulmo
19/21
Than3
8/9/2019 Case Report Bahrum Pulmo
20/21
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
8/9/2019 Case Report Bahrum Pulmo
21/21
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