Case 85

 A seventy eight-year-old female was transported from the local neurosurgeon hospital by an ambulance car because she got suspicious pneumonia diagnosed by chest CT. She had suffered from fever and appetite loss for the previous one week. As the past medical history, she had received neurosurgery for cerebral aneurysm. Saturation oxygen pressure with 2L/min oxygen was 92%, body temperature 39^◯C and heart rate 100/min blood pressure 106/62 mmHg. Laboratory test revealed: white blood cells 1960/mm³, neutorophils 88.2%, lymphocytes 8.7%, monocyte 2.6%, platelets 44000/mm³, total bilirubin 2.31 mg/dL, LDH 309 U/L, PTINR 1.25,Na 120 mEq/L, K 3.3 mEq/L, Cl 90 mEq/L, D dimer 8.30 μg/ml (< 1.0), CRP 9.80 mg/dL. She agreed to receive chest CT again in our hospital.

What is your diagnosis based on clinical symptoms and images(Figs.1-5) of chest CT ?

1. Pneumonia and bronchiolitis

2. Miliary sarcoidosis

3. Miliary tuberculosis

4. Alveolar cell carcinoma and metastases

5. Pulmonary alveolar microlithiasis

answer

2017.12.20