Case 189

 An eighty seven-year-old male presented in our hospital for breathing difficulty, appetite loss, edematous lower extremities and wheezing. He had previously brain stem infarction one year before and thereafter dementia was advanced with being hard to communicate with others. He had been given antihypertensives. He was prescribed nitrites and diuretics. He got oxygen inhalation. Laboratory test revealed CRP 1.78 mg/dL, white blood cells 10520/mm³ neutrophils 87.5%, lymphocytes 6.3%, LDH 568 U/L, creatinine 2.32 mg/dL, BNP 265.2 pg/mL (< 18.4) troponin 233.9 pg/mL (< 26.2). Under suspicious cardiac failure, he took chest radiograph and chest CT(Figs. 1-4).

What is your diagnosis ?

1.　Pericardial effusion

2.　Pericardial hemorrhage

3.　Cardiac infarction

4.　Dissecting aneurysm of ascending aorta

5.　Malignant tumor

answer

2020.5.13