CASEPRESENTATIONPRESENTEDBY:SOORIAHNOUSAPURSUNSHEETALSINGHGENERALPRESENTATIONJINYUKANG,MALE,31YRSOLD,FROMLEQING,WENZHOU,OFFICEWORKERADMITTEDONTHE1STAUGUST2015COMPLAINEROFHISTORY:PATIENTHIMSELFCHIEFCOMPLAINT:HEMOPTYSISFOR2DAYSHISTORYOFPRESENTILLNESS2daysago,thepatientstartedcoughingupbloodsuddenly,20coughseachtime,30-50mlofblood.Thesputumcontainedfreshblood.HewenttolocalhospitalwherehedidaCTscanandwasdiagnosedwithaspirationpneumoniaandbothlungshadinfectivelesions.Hewasprescribedwithantibiotics(notspecified).However,hissymptomswerenotrelieved.Hecametoourhospitalandgotadmitted.Hisconsciousnesswasclear,alert,goodappetite,goodsleep,yellowsoftstool,clearurineandnochangeinweight.NOPASTMEDICALHISTORYPERSONALHISTORYFromwenzhouDrinkerfor15yrs,drinksabout600mlbeerperdaySmokerfor15yrs,smokes20cigarettesperdayGotmarriedwhenhewas24yrsold,nowdivorced.Has1son,healthy.FAMILYHISTORYFatherdeceased,nocausespecifiedMotherliving,healthy.Brothersandsistersallhealthy.Nohereditarydiseases.PHYSICALEXAMINATIONT:36.3degreesCelsius,P:119bpm,BP:136/86mmhg,R:20/minConsciousnessclear,alertSymmetricalvocalfremitus,lungexpansion6cmNootherremarkablesignsFURTHEREXAMINATIONSCTBRTBLOODBIOCHEMISTRYTUMORMARKERSULTRASOUNDECGSPUTUMCULTURELungbiopsybronchoscopyLABRESULTSMONOCYTES0.7x10^9/LBASOPHIL0.1x10^9MEANPLATELETVOLUME7.1flPCO222.4mmol/LPartialpressureofpulmonaryartery152.5mmHgHCO3-24.9mmol/LpH7.42CRP17.7mg/LBloodglucose6.6mmol/LD-Dimer0.62mg/LBNP259pg/mLTotalprotein55.1g/LAlbumin30.8g/LBUN9.9BloodgroupA,RH+ESR27mm/HPathologyreport:ciliatedcellspresent,notumorcells.CTSCANMEDIASTINALWINDOWCTABRONCHOSCOPYDILATEDCAPILLARIES,INFLAMMATORYINFILTRATIONSPRIMARYDIAGNOSISLUNGINFECTIONPULMONARYVESSELSABNORMALITYDIFFERENTIALDIAGNOSISAbnormalityofpulmonaryvessels(needCTAtoconfirm)Bronchiectasis(needHRCTtoconfirm)TB(T-SPOTnegative)Lungcancer (Tumormarkersnegative,biopsynegativefortumorcells)Pulmonarythromboembolism (D-Dimertestpositive,CTnegative)TREATMENTPLANPhentolaminelevofloxacinHomeostaticagentsProteinsupplementVitaminsSupportivetherapyBedrestSymptomatictreatments2ndTIMEADMISSION

Jinyukang,31yrsold,Male,Divorced,fromLeQing,Wenzhou,officeworker.Admittedonthe29thAugust2015.Chiefcomplaint:hemoptysisformorethan20days,recurrence4days.HISTORYOFPRESENTILLNESS20daysago,thepatientstartedcoughingupbloodsuddenly,20coughseachtime,30-50mlofblood.Thesputumcontainedfreshblood.Hewasadmittedintherespiratorydepartmentandwastreatedwithlevofloxacinandphentolamineandhemostaticagent.Hissymptomswererelievedandgotdischargedfromthehospital.4Daysago,hefoundbloodinhissputumagain.Thistime,thevolumewaslesser.Hisconsciousnesswasclear,alert,goodappetite,goodsleep,yellowsoftstool,clearurineandnochangeinweight.PHYSICALEXAMINATIONT:36.5degreesCelsius,R:20/min,BP:130/76mmhg,P:100bpm.Onauscultation,pleuralfrictionrubscouldbeheardintheleftlowerlobeofthelungandmoistralesontherightlowerlobe.Abdomenwasflatandsoft,notenderness,nospidernevus,noedemaoflowerlimbs,noshiftingdullness,…FURTHEREXAMINATIONCTBRTBLOODBIOCHEMISTRYTUMORMARKERULTRASOUNDECGLUNGBIOPSYCTSCANMEDIASTINALWINDOWECHOCARDIOGRAPHYULTRASOUNDREPORTHYPERTROPHYOFLEFTVENTRICLEANDLEFTATRIUMMILDDEGREEOFTRICUSPIDREGURGITATIONWITHMODERATEPULMONARYARTERYHYPERTENSIONDECREASEDCONTRACTILITYOFLEFTVENTRICLELABRESULTSWBC10x10^9/LMonocytes1.3x10^9/LPlateletcount0.3/LCRP100mg/LD-Dimer0.72totalprotein60.8Albumin33.3GGT178U/LBUN6.4Triglycerides2.19mmol/LLDL4.6mmol/LTotalcholesterol6.41mmol/LESR46T415.39pmol/LT31.33nmol/LPO277.6mmHgPCO222.4mmol/LHCO3-25mmol/LTreatmentplantransferredtocardiothoracicsurgerydepartmentonthe1stofseptemberHISTORYOFPRESENTILLNESS35daysago,whilethepatientwascoughing,henoticedhissputumwaspinkincolour.Thebloodvolumewaslittle.Thistime,hissymptomsweresamelikelasttimeadmissionandwithinthenighthewashavingdyspnea.Afteractivity,hecouldfeelchesttightness,shortnessofbreathwhichwasrelievedbyrest.1daylater,hecametoourhospitalandgotadmitted.Hisconsciousnesswasclear,alert,goodappetite,goodsleep,yellowsoftstool,clearurineandnochangeinweight.NOPASTMEDICALHISTORYPHYSICALEXAMINATIONT:36.3degreesCelsius,P:14bpm,BP:112/66mmhg,R:20/minAmurmurcouldbeheardnearthemitralvalveregion.OtherphysicalexaminationnotremarkableDuroziez’ssignnegativeWHATISDUROZIEZ’SSIGN?WHATISTHESIGNIFICANCEDUROZIEZ’SSIGN?DUROZIEZ’SSIGNDuroziez'ssign

isasignof

aorticinsufficiency.

Itconsistsofanaudiblediastolicmurmurwhichcanbeheardoverthe

femoralarterywhenitiscompressedwiththebellofastethoscope.LABRESULTLYMPHOCYTES3.38x10^9Plateletcount0.32flTotalprotein60.5g/LAlbumin32.3g/Lalb/Globulin1.1HCO3-14.8mmol/LUricacid500umol/LTotalcholesterol6.41mmol/LTriglycerides3.21mmol/LHDL0.82mmol/LLDL4.37mmol/LTroponin<0.01ug/LMyoglobin25.9ng/LDIFFERENTIALDIAGNOSISMITRALVALVEINSUFFICIENCY(becauseitwillcausehypertensiveheartdisease)