2026-11-11 (三) 18:30 ~ 20:30

2026年南區胸腔病例討論會

 2026 Chest case discussion

摘要課程表

  連絡人：內科部曾玲雯  07-3351121#3075

          外科部吳佳宣  07-3351121#3076                                                                                            

場次	會議日期	時間	主持人
1	2026年11月11日	18:30-20:30	蕭惠元、楊明泉等
		地點：H2O HOTEL水京棧國際酒店 地址：高雄市鼓山區明華路366號
2	2026年12月09日	18:30-20:30	蕭惠元、楊明泉等
		地點：韻藏中餐廳 地址：高雄市左營區新上里至聖路297號

 

場次1

18：30-19：00討論病例

Name: 湯歐xx

Age : 73year-old 

Gender: male

Chart NO: 1017677

C/C :

SOB for about 3-4 days

Past history :

1.  Hypertension

2.  Hyperlipidemia

3.  Type 2 diabetes mellitus

4.  Chronic kidney disease, stage III

腎臟科 (門診) 劉怡俊

   BISOPROLOL 5mg/tab(CONCOR) 1 tab BID

   Empagliflozin-LINAgliptin 25mg/5mg tab(Glyxambi) 1 tab QD

   Vitamin B12(Mecobalamin) 500mcg/cap(Methycobal) 1 cap BID

   Insulin glargine inj. 450unit/1.5mL/pen(Toujeo) 38 unit QD 

   Sevikar-5/40mg(Sevikar) 1 tab QD

   Pioglitazone-Metformin 15mg-850mg/tab(Lodiglit) 1 tab BID

   Niacin-Lovastatin 500/20mg1tab(Linicor) 1 tab HS

Ø  Operation history: denied

T: travel history: denied. in recent three months

O: occupational hitory: denied

C: contact history: denied

C: cluster history: no family and friend with the similar symptoms

 

Family history:

Denied other familial heredity disease

Diabetes mellitus: Mother

個人病史：

[Personal History]-->

Allergy: Ezetimibe-Atorvastatin10/20mg

Smoking: Denied 

Alcohol: Denied

Betel nut:Denied 

Coffee: Denied

Tea:Denied 

Exercise:Denied 

理學發現：

[PE]-->

General Apperance: Healthy looking

Alert and well oriented 

Coma scale: E:4 ; V:5 ; M:6 

BH: 152cm ; BW: 59kg ; BMI: 25.54kg/m2

Temp: 36.4°C ; Pulse: 114per min ; Respiration: 18per min ; BP: 183/97mmHg 

[Head]-->

Apperaance: Normal in size, Contourscalp, Scalp appearance and position 

[Eyes]-->

Sclera: Normal, Conjunctiva: Normal 

 [Ears]-->

Auricles: Normal, In configuration, Positive alignment 

Canals: Normal 

Tympanic Membranes: Normal 

Hearing: Normal 

[Nose and Sinuses]-->

Normal: Appearance ; Smell 

[Throat and Mouth]-->

Lips: Normal, Teeth: Normal, Tongue: Normal 

[Neck]-->

Appearance: Normal, Scar:Normal , Jugular vein:Normal ,  

Thyroid: Normal, Tonsil:Normal

[Chest]-->

Inspection: Contour no deformity, thorax symmetrical expansion ;

Normal breathing pattern ; Normalities of the skin 

Palpation: Normal tactile fremitus symmetric 

percussion: Resonant throughout bilateral chest wall 

Ausculation: Clear breathing sound, bilateral 

[Inspection]-->

Normal: Symmetry ; No skin color changes ; No nipple discharge 

[Palpation]-->

Normal: No mass ; No nipple discharge 

[Heart]-->

Inspection: Normal 

Palpation: Normal 

Auscultation: No murmur ; Regular ; No Bruit 

[Inspection]-->

General Contour: Unremarkable  

Scar: No Scar 

Wound: No Wound 

Hernia: No Hernia 

[Auscultation]-->

Bowel Sound: Normoactive bonel sound 

[Percussion]-->

Tympanic sound: Unremarkable 

[Assesses]-->

Palpation: Soft 

Tenderness: No Tenderness 

Rebound tenderness: No Rebound tenderness 

Mass: No palpable mass 

[Upper]-->

Inspection: Normal (no deformity, no wound ) 

Palpation: Normal (warm, no mass or crepitus) 

Special test /Special finding: Non special finding 

[Lower]-->

Inspection: Normal (no deformity, no wound ) 

Palpation: Normal (warm, no mass or crepitus) 

Special test /Special finding: Non special finding 

[Spine System]--> Palpable: No mass 

Posture: Normal ( Spine and extremities in good alignment/ Symmetrical of body parts )

入院經過:

  This 73-year-old woman suffered from SOB for about 3-4 days prior to admission. Associated symptoms included mild cough, poor appetite. There was no fever, chills, sorethroat, running nose, sputum and was no nausea, vomiting, diarrhea, BW loss.

  At our ER on 7/11. CXR arranged. The Lab showed leukocytosis with elevated CRP. Initial vital signs revealed 35.6C/95/18 SPO2:94, BP: 180/81mmHg. Blood culture was collected prior to antibiotics(Brosym 4000mg ivd stat). Hydration with symptoms relief was used. Under impression of 1.Right massive pleural effusion, cause to be determined. She was admitted.

 

19：00-19：30討論病例

 

Name: 葉 張 xx

Age : 68year-old 

Gender: Female

Chart NO: 2777920

C/C :

Mild SOB for about 1 month

Past history :

Denied any systemic disease

Operation history: Denied

T: travel history: denied. in recent three months

O: occupational hitory: Housewife

C: contact history: denied

C: cluster history: no family and friend with the similar symptoms

Family history:

Denied family history of Hypertension, Type 2 diabetes mellitus, CAD, CKD, Cancer

個人病史：

[Personal History]-->

Allergy: Denied

Smoking: Denied

Alcohol: Denied Betel nut:Denied 

Coffee: Denied

Tea: Regular 

Exercise:Denied 

理學發現：

[PE]-->

General Apperance: Healthy looking

Alert and well oriented 

Coma scale: E:4 ; V:5 ; M:6 

BH: 150cm ; BW: 45kg ; BMI: 20kg/m2

Temp: 36.2°C ; Pulse: 62per min ; Respiration: 18per min ; BP: 129/83mmHg 

[Head]-->

Apperaance: Normal in size, Contourscalp, Scalp appearance and position 

[Eyes]-->

Sclera: Normal, Conjunctiva: Normal 

 [Ears]-->

Auricles: Normal, In configuration, Positive alignment 

Canals: Normal 

Tympanic Membranes: Normal 

Hearing: Normal 

[Nose and Sinuses]-->

Normal: Appearance ; Smell 

[Throat and Mouth]-->

Lips: Normal, Teeth: Normal, Tongue: Normal 

[Neck]-->

Appearance: Normal, Scar:Normal , Jugular vein:Normal ,  

Thyroid: Normal, Tonsil:Normal

[Chest]-->

Inspection: Contour no deformity, thorax symmetrical expansion ;

Normal breathing pattern ; Normalities of the skin 

Palpation: Normal tactile fremitus symmetric 

percussion: Resonant throughout bilateral chest wall 

Ausculation: Clear breathing sound, bilateral 

[Inspection]-->

Normal: Symmetry ; No skin color changes ; No nipple discharge 

[Palpation]-->

Normal: No mass ; No nipple discharge 

[Heart]-->

Inspection: Normal 

Palpation: Normal 

Auscultation: No murmur ; Regular ; No Bruit 

[Inspection]-->

General Contour: Unremarkable  

Scar: No Scar 

Wound: No Wound 

Hernia: No Hernia 

[Auscultation]-->

Bowel Sound: Normoactive bonel sound 

[Percussion]-->

Tympanic sound: Unremarkable 

[Assesses]-->

Palpation: Soft 

Tenderness: No Tenderness 

Rebound tenderness: No Rebound tenderness 

Mass: No palpable mass 

[Upper]-->

Inspection: Normal (no deformity, no wound ) 

Palpation: Normal (warm, no mass or crepitus) 

Special test /Special finding: Non special finding 

[Lower]-->

Inspection: Normal (no deformity, no wound ) 

Palpation: Normal (warm, no mass or crepitus) 

Special test /Special finding: Non special finding 

[Spine System]--> Palpable: No mass 

Posture: Normal ( Spine and extremities in good alignment/ Symmetrical of body parts )

入院經過:

  This 69-year-old woman suffered from mild SOB for about 1 month prior to admission. Associated symptoms included cough with whitish sputum. There was no fever, chills, sorethroat, nasal obstruction and was no nausea, vomiting, abdominal distension, diarrhea, dysuria, loss of body weight. On 10/28m, she visited our CM clinic where mass lesion on LUL, RUL by CXR. Symptoms relief was also used. Under impression of 1.Mss lesion on LUL, RUL, suspect lung cancer. She was admitted.

 

 

19：30-20：00討論病例

 

Name:黃xx

Age : 76 year-old 

Gender: male

Chart  No : 957224

C/C : CXR : chronic cough for 6+ months , and and intermittent hemoptysis persisting for 2~3 months

Past history :

1. Pleural tuberculosis treated 20-30 years ago (高長)

2. Benign prostatic hyperplasia (自行購買電視廣告的保養品)T.O.C.C>:

Travel history:Denied

Occupation: (拆船 for more than 30 years)

Contact history: -

Pet/Animal:Denied

Cluster:共同居住的家人(或朋友、同學)是否有其他2人(含)有類似症狀:Denied

History of venereal disease (隱私'性'的疾病): Denied

家族史：

Family history:

- Month :  Stomach cancer

- Heart disease: nil

- Renal disease: nil

- HBV/HCV: nil

- Pulmonary disease: nil

- Hypertension: nil

- Diabetes Mellitus: nil

個人病史：

[Personal History]-->

Education:junior-high 

Marital status: Marital

Exercise:no

Alcohol: 高粱約半瓶、啤酒3-4罐 daily for 50 years

Tobacco:  3PPD for 50 years, quit 1year

Coffee: no

Tea: no  

Betel nut: no 

理學發現：

[Vital Sign]

--> BH: 157.5cm BW:.63.5kg

Temp:36.50 C   BP: 132/75mmHg

   PR:102/min    RR:18/min

 [General appearance]

--> Consciousness:alert  GCS:(E4V5M6 ) 

Development:normal 

Nourishment:well 

[Ear]

--> EEC:clear 

Hearing:normal 

 [Throat]

--> Tonsil:normal 

Tongue:normal 

Pharynx:normal 

[Nose]

--> Discharge:no 

Smelling:normal 

[Thyroid]

--> Size:non-palpable  Nodule:non  Tender: - 

 

[Eye]

--> Conjunctiva: not anemic 

Sclera: not icteric 

Pupil size, R't: 2mm  Pupil size, L't: 2mm 

   Light reflex (R/L):+/+  Shape:regular

[Lymph Node]

--> Cervical:non palpable 

Axillary:non palpable 

Inguinal:non palpable

    Consistency:soft

[Chest]

--> Contour:normal 

Percussion:reasonant 

Breathing sound: clear 

Heart beat:regular 

   Heart sound:no murmur 

 [Abdomen]

--> Liver: non palpable 

Spleen: non palpable 

Mass:no 

Tenderness:no 

   Bowel Sound:normal 

Rigidity:non 

Ascites:non 

Distension:no 

   Hernia:normal 

 [Spine & Extremities]

--> Spine:normal 

Upper extremities:normal 

Lower extremities:normal 

Nail:normal 

入院經過:

    A 76-year-old man with a medical history that included benign prostatic hyperplasia and treatment for pleural tuberculosis 20-30 years prior presented with a chronic cough. His cough had persisted for six months and had worsened over the past two months, accompanied by intermittent coughing up blood and dyspnea, particularly when recumbent. He reported that drinking water and consuming eight-scented guava (baxian guo) fruit temporarily relieved his cough. He denied any fever, nasal congestion, runny nose, chest tightness, chest pain, nausea, vomiting, or diarrhea. He had a significant history of smoking three packs per day for 50 years but had quit smoking one year prior. He initially presented to the thoracic clinic due to symptoms on September 18, 2025, and underwent bronchoscopy on September 5, 2025, which diagnosed him with non-small cell lung cancer (NSCLC), possibly squamous cell carcinoma of the left lower lobe. Examination revealed localized invasion of the cancer into the mediastinum, leading to admission for concurrent chemoradiotherapy (CCRT).

On admission, the patient had no fever, only a mild cough, stable vital signs, and a blood oxygen saturation of 100% on room air. Following a consultation with the Radiation Oncology Department on September 25, a treatment plan was developed for lung cancer and mediastinal lymph node resection. The prescribed dose was 5400 cGY in 30 divided doses, scheduled to begin on September 26, 2025. A Port-A catheter implatation in Left clavicle was placed after consultation with the Thoracic Surgery .

On September 26 , The  Karnofasky Performancescale--80 normal activity with effort ; some sign or symptoms of disease ,CCRT with Cisplatin 32.8mg920mg/M2) + taxotere  32.8mg(20mg/M2) inserted via a Port-A catheter. and Supportive care included fluid replacement and relief of cough and bone pain .

On the second day after chemotherapy, the patient's no vomit or nausea , clinical symptoms were generally stable and he had no particular discomfort. He was discharged on September 27 and received follow-up treatment as an outpatient.