2025-11-12 (三) 15:00 ~ 17:00

2025年南區胸腔病例討論會

 2025 Chest case discussion

摘要課程表

地  點：阮綜合醫院  B棟十樓大教室

地  址：高雄市苓雅區成功一路162號      連絡人：

                                                   內科部曾玲雯07-3351121#3075

                                                   林莞茹專科護理師07-3351121#2258

場次	會議日期	時間	主持人
1	2025年11月12日	15:00〜17:00	蕭惠元、楊明泉等
2	2024年12月10日	15:00〜17:00	蕭惠元、楊明泉等

 

場次1

15：00-15：30討論病例

Name: 呂xx

Age : 65 year-old 

Gender: male

Chart NO: 588521

C/C :

Admitted for lung biopsy

Past history :

1.Type II diabetes mellitus for years, with regular medication control and follow up at 維康診所

2. Hypertension for years, with regular medication control and follow up at 維康診所

3. Chronic kidney disease, stage 3b

4. Hyperlipidemia for years, with regular medication control and follow up at 維康診所

5. Asthma or COPD: denied

6. Heart disease: denied

7. Hepatitis B or C: denied

8. Genitourinary tract disease: denied

9. Malignant tumors

維康診所

Acetylsalicylic acid 100mg/cap(Bokey) 1 cap QD po

Isosorbide 5-mononitrate 20mg/tab(Coxine) 0.5 tab QD po

Cetirizine Hydrochloride 10mg/tab(CETY FILMCOATED) 1 tab QD po

Dipyridamole 25mg/tab(Dipyridamole) 1 tab QD po

Rosuvastatin Calcium 5mg/tab(Robestar Sandoz Filmcoated) 1 tab QOD po

Amlodipine 5mg/tab(Norvasc) 1 tab QD po

DOXAZOSIN 4mg/tab(DOXABEN XL) 1 tab HS po

Amlodipine-Valsartan 5/80mg tab(Exforge 5/80) 1 tab QD po

Dapagliflozin 10mg/tab(Forxiga) 0.5 tab QD po

Nebivolol 5mg/tab(Nebilet) 1 tab QD po

Ø  Operation history:

1. Right 肩胛骨 post op for 10 years.

2. URSL for right ureteral stones(U/3 and M/3) on 2011/07/05

3. ESWL for right(L/C) on 2013/8/21

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 family history

1.Type 2 diabetes mellitus : family (-).

2. Hypertension : family (-).

3. Hyperlipidmeia : family (-).

4. Cancer : family (-).

個人病史：

[Personal History]-->

Allergy: Denied 

Smoking:1 PPD for many years 

Alcohol:有:(種類) beer

Occasionally and small amount only 

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: 170cm ; BW: 110kg  ; BMI: 38.06kg/m2

Temp: 35.2°C ; Pulse: 63per min ; Respiration: 19per min ; BP: 150/105mmHg 

[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: Obese 

Scar: No Scar 

Wound: No Wound 

Hernia: No Hernia 

[Auscultation]-->

Bowel Sound: Normoactive bonel sound 

[Percussion]-->

Tympanic sound: Unremarkable 

[Assesses]-->

Palpation: Unremarkable 

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:

  The 66-year-old male patient reports having had Type 2 diabetes mellitus, Hypertension, Chronic kidney disease and Hyperlipidemia for years and has been receiving regular follow-ups at 維康診所.

  According to the patient, he was admission in our hospital from 02/15-02/21 for treatment of pneumonia. Since his last discharge, he has been regularly followed up at the chest medicine outpatient clinic of our hospital. A chest X-ray on 02/25 showed a patchy density persisting in the right middle lung zone. However, a follow-up chest X-ray on 03/25 revealed increased infiltration over the bilateral lower lungs. A further chest CT (without contrast) was arranged on 03/28, which revealed an irregular consolidation at the right lower lobe (RLL) adherent to the right major fissure, malignancy can't be excluded. Therefore, he was advised to be admitted for a chest CT-guided biopsy to further clarify the diagnosis.

  Based on the above, the preliminary diagnosis is 1) Right lower lobe lesion, malignancy can't be excluded. Due to the above problems, he was admitted for further management.

15：30-16：00討論病例

Name: 吳xx

Age : 84 year-old 

Gender: male

Chart NO: 2724943

C/C :

cough and occasionally chest wall pain

Past history :

1.Hypertension(+)

2.Type II diabetes mellitus:(-)

3.Hepatitis-B(-),Hepatitis-C(-)

4.Heart disease(+)

Ø  Operation/ admission history:

-20多年前因車禍導致右腳骨折開刀(內固定未移除)

-113年因車禍導致左手骨折開刀(內固定未移除)

Ø  Allergy history.

   Drug allergy: never

   Denied food allergy (Seafood, Broad bean, Peanut, Shrimp, Crab)

Family history:

Denied family history

1.Type 2 diabetes mellitus : family (-).

2. Hypertension : family (-).

3. Hyperlipidmeia : family (-).

4. Cancer : family (-).

個人病史：

[Personal History]-->

Occupation: retired

Education: senior-high   

Marital status: married

Exercise: regular

Alcohol: No

Tobacco: No 

Coffee: No

Tea: No

Betel nut:no 

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

理學發現：

[Vital Sign]

--> BH:139.0cm ; BW:57.3kg ; Temp:35.7C ; BP:139/94 mmHg

   PR:72 /min RR:16 /min

 [General appearance]

--> Consciousness:alert  GCS:(E4V5M6 ) 

Development:normal 

Nourishment:well 

[Ear]

--> Hearing:normal 

[Nose]

--> Discharge:no 

--> Smelling:normal

[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: hernia, left  

 [Spine & Extremities]

--> Spine:normal 

Upper extremities: normal

Lower extremities: normal 

Nail:normal 

入院經過:

  This 84-year-old female suffered from cough and occasionally chest wall pain, she went to LMD for help but the symptom didn't improve. So, she was visited our OPD help.

  At OPD, the followings are physical examination findings : con's alert, clear breathing sound, soft abdomen. Four extremities are freely movable ; Image was follow as chest CT for plaining treatment, it shows lung nodule, RUL , and mediastinal lymph nodes enlargement; under the impression of lung nodule, RUL, and mediastinal lymph nodes enlargement, so she was admitted for further investigation and management.

16：00-16：30討論病例

Name: 莊xx

Age : 64 year-old female

Chart NO: 1225203

C/C : Two lung lesion with progression in years

Past history :

hypertension ,Hyperlipidemia,anxiety,arrhythmia and dizziness (+)

Drug allergy: NKA

married, G1P1A0, C/Sx 1, LMP:97-09-21

drinking and smoking(+); Hx of hypotension(+)

OP: C/S x 1

Cataract in right eye s/p for years

hemorrhoidectomy on 2019/05/22

家族史：

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

旅遊史：

TOCC:

Travel history in recent 6 months ago: denied

Occupation:看護

Contact history: animal contacthistory: denied

Illness contact history:denied

Cluster: denied family and friend with the similar symptoms

個人病史：

[Personal History]-->

Occupation:Worker 

Education:junior-high 

Marital status:married 

Exercise:no 

Alcohol:no 

Tobacco:regular,30支/days 

Coffee:no  Tea:no 

Betel nut:no 

Drugs:Anti-H/T; Oral pill 

Allergy:never  動物接觸史:無 

理學發現：

[Vital Sign]--> BH:162 cm BW:62.2 kg Temp:36.5 度C BP:135/90 mmHg

             PR:66 /min RR:18 /min

[General appearance]--> Consciousness:alert  GCS:(E4V5M6 )  Development:normal  Nourishment:well 

[Ear]--> EEC:clear  Hearing:normal  TM:not-test 

[Throat]--> Tonsil:normal  Tongue:normal  Pharynx:normal  Mouth floor: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 

[Ophthalmosopic]--> Ophthalmoscopic:none test 

[Neck]--> Neck:supple  Jugular vein:0 cm from sternal notch

[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:hypoactive  Rigidity:non  Ascites:non  Distension:no 

             Hernia:normal 

[Genitalia]--> Genitalia:not-test 

[Rectal]--> Anus:none test  DRE:none test 

[Spine & Extremities]--> Spine:normal  Upper extremities:normal  Lower extremities:normal  Nail:normal 

入院經過 :       

   A 64-year-old woman who has hypertension ,Hyperlipidemia,anxiety,arrhythmia and dizziness for years with medication control. She suffered from Two lung lesion with progression in years , CT  guided  biopsy  for  RUL  mass on 2024/06/03. The pathologic diagnosis show Adenocarcinoma in situ, at least ---- lung, right upper lobe, CT-guided biopsy.

   She was come to our OPD , the following Physical examination findings :  con's alert, clear breathing sound, soft abdomen. Four extremities are freely movable. Image was follow as PET-Whole Body for plaining treatment, it shows 1.Primary lung cancer in the RUL (the  larger one) is compatible.2. Another low metabolic smaller ground-glass lesion in the RUL. 3.Favor reactive lymph nodes in the bilateral  mediastinal and pulmonary hilar regions. 4.Favor physiological  uptake or inflammation in the stomach.5.Favor mild inflammation in  the left wrist joint.6.The staging according to F-18 FDG PET/CT is  T1bN0M0 (8th AJCC system). 

   under the impression of adenocarcinoma of lung , RUL s/p CT guide biopsy ,she was admitted for further evaluation and management.