Case 152

 A seventy nine year-old male presented in our hospital suffering from cough, sputum, chest pain, nausea and slight fever for five days. He had felt fatigue and appetite loss for the previous two weeks. For several days, he got only milk as a meal before coming. In the past, he smoked tobacco 20 pieces/day for 55 years. He had several major diseases; esophageal cancer, rectal cancer, left inguinal hernia, brain infarction and emphysema. Besides, he experienced pneumothorax and pleural effusion eight months before. At present, respirate rate was 20/min and SpO2 was 93 mmHg. Laboratory test revealed white blood cells 7500/mm3, CRP 24.7 mg/dL, albumin 1.7 g/dL. Chest radiograph showed consolidation in the upper right lung. He received chest CT for further investigation (Figs. 1-4).

 He was admitted in our hospital. The physician in charge checked his previous chart and chest CT (Fig. 5) and found the data of right pleural effusion of eight months ago, revealing total protein 5.5 g/dL, lymphocytes 90%, adenosine deaminase (ADA) level 54.5 U/L (< 40).

What is your diagnosis ?

1. 　Mycotic pneumonia

2. 　Viral pneumonia

3. 　Bacterial pneumonia

4. 　Tuberculosis pneumonia

5. 　Pleulitis carcinomatosa

answer

2019.7.10