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 ！