Case 38 – History


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Case 38

Lung mass


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Brief History of Present Illness

The patient was a middle-aged Caucasian man with a history of Crohn’s disease, obesity, sleep apnea, hypertension and medication-controlled atrial fibrillation who had an incidental right lower lobe lung mass identified on abdominal CT.

Multiple biopsies were negative for malignancy, with the latest biopsy aborted due to technical difficulties.

A presumptive diagnosis of cancer was made based on radiography.


Hospital Course

The patient underwent partial right lower lobectomy using the VATS procedure with right chest tube placement.

In the immediate postoperative period, the patient developed atrial fibrillation with a rapid ventricular rate and was treated with amiodarone.

Multiple x-rays showed bibasilar atelectasis; and the development of left upper lobe density.

Pathology of the lung mass showed a necrotizing fungal granuloma.

The patient was treated with IV antifungal medication and converted to oral antifungal medication.

The patient was discharged home after approximately one week.


Home events

At home, he had persistent diarrhea and diaphoresis for several days.

He underwent cardiopulmonary arrest.


Paramedic care

Paramedics were called who performed CPR, gave epinephrine and intubated the patient.

He was brought into the emergency room.


Emergency room events – physician note


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Emergency room events – nursing notes


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CT Abdomen and Pelvis without contrast (report from emergency room records)


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Emergency room events, continued

The patient despite resuscitative efforts.


Next: External exam

Discussion Questions

1. Summarize the history.
2. Based on the history, what do you anticipate are risk factors in the patient’s death?
3. Based on the history, what organs do you suspect might have pathology related to the cause of death?
4. Based on the history, what organs do you suspect might remain normal despite the patient’s illness.