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Case 2by 李君思远 0456180
Briefly
A 49 year-old woman presented with high fever and chills, jaundice, and upper abdominal pain for 3 days.
The patient was a recent immigrant from Argentina. One year before, she frist noticed a sensation of fullness in the right upper quadrant of her abdomen. Her past medical history was unremarkable. In her country of origin, she had been health and active, working in the field and breeding and raising sheepdogs.
Physical Examination
VS: T 39.5 C, P112/min, R 18/min, BP102/60 mmHg
PE: The patient appeared acutely ill and was obviously jaundiced. Right upper quadrant abdominal tenderness was noted.
Laboratory Studies
WBC 22400/μl, Differential 55% PMNs, 20%bands, 12% lymphs, 8% eosinophils
Serum chemistries: alkaline phosphatase 340 U/L bilirubin 4.3mol/L
Imagine
A CT scan of the liver demonstrated a large multiloculated cyst with bile duct dilation.
Primary Diagnosis
Review the Case History
The patient was a recent immigrant from Argentina. One year before, she frist noticed a sensation of fullness in the right upper quadrant of her abdomen. Her past medical history was unremarkable. In her country of origin, she had been health and active, working in the field and breeding and raising sheepdogs.
Life cycle
Echinococcus granulosus
Hydatid
Microscopyprotoscolex
Clinical Features
Long incubation period
Hepatic involvementPulmonary involvement Brain involvementRupture of the cysts
Clinical Diagnosis
Case history is necessary Including occupation, native place, etc A tender mass in abdomen is of great help to
diagnosis Imaging techniques:X-ray, CT, MRI,etc
Lab Diagnosis
etiologic tests are often helplessserologic tests are ways of auxiliary dia
gnosis fine needle biopsy may be useful,but be
ware the leakage of hydatid fluid or protoscolices
Treatment
Surgery(most common)
Medication(after surgery)
Dilemma Why not diagnose the disease as an…
3X !