Mystery Quiz

September 19, 2008

Posted by Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors

The patient is a 76 year old man with history of moderate-to-severe COPD who presented with three days of fever, breathlessness, and productive cough. Past surgical history is significant for vagotomy and partial gastrectomy 16 years earlier and a cholecystectomy 10 months prior to admission. On exam, the patient appeared acutely ill with a blood pressure of 75/45 mmHg, tachycardia, marked hypoxemia and course breath sounds throughout all lung fields. Labs revealed a white count of 2.7 K with 53% bands. The creatinine was elevated to 3.0 mg/dl from a baseline of 1.0 mg/dl. ABG showed pH 7.00, pCO2 61 mmHg, pO2 79 mmHg on 100% O2, and arterial lactate 5.2 mmol/L.

 

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Image 1 – Baseline Chest Radiograph 10 months prior to admission

 

 

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Image 2 – Admission Chest Radiograph

 

 

The patient required pressors for hypotension unresponsive to IV fluids, mechanical ventilation, and broad spectrum antimicrobial therapy.

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Image 3 – Chest Radiograph from HD 1

 

 

Six days later, the chest radiograph revealed:

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Image 4 – Chest Radiograph HD 6

 

 

 


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One Response to Mystery Quiz

  1. Mystery Quiz- The Answer | Clinical Correlations on November 3, 2013 at 11:26 am

    [...] answer to last week’s mystery quiz is pneumatocele/pseudocyst likely due to ventilator associated lung injury (VALI) in a patient with [...]

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