Presented by Int. 楊為傑 Int. 吳建霆 Intern Seminar Presented by Int. 楊為傑 Int. 吳建霆

Identification data Name: Mr. Huang Sex: male Age: 75 years old Admission date: 2005/9/5 Chart number: 01117606

Chief complaint Cough was noted for 7-8 years and was getting severe recently.

Present illness Then he was transferred to NCKUH. Surgery was suggested, but he hesitated. Had cough for 6-7 years. Went to 衛生所 and took a CXR. 2004, Apr. 2004, Feb. Transferred to 新樓，Took a Chest CT. He was told that he had thymoma He was followed up at OPD. Cough was getting severe since early 2005. Dyspnea on exersion (+)

Present illness Patient accept surgery in middle 2005. Had MRI on August, 2005. Admitted on 2005/9/5

Present illness Cough (+), getting severe in recent 6 months. Dyspnea on exertion (+) No chest pain, no fever, no night sweat, no weight loss. No muscle weakness

Past history No hypertension No DM Drug allergy history: neurotin Alcohol(+), 20-30cc 藥酒 for several decades smoking(+), half pack/day for 40+ years. quitted since 1996 No family history of malignancy

Physical examination Appearance: fair Consciousness: clear Appearance: fair BT: 36.4C, P: 76 /min, R: 18 /min, BP: 132/74 mmHg Activity: fair Conjunctiva : not pale sclera: not icteric, no ptosis Neck: supple, LAP(-) Chest: symmetric expansion, subcostal retraction( - ) breathing sound: clear, no crackles Heart: regular heart beat, no murmur Abd: soft, not distended Liver/ Spleen: impalpable / impalpable, No tenderness, No rebounding pain BS:normoactive Extremities: freely movable, pitting edema (+)grade I at lower extremities. Skin:turgor fine, no rash

Lab data GOT GPT BUN Cr GLU BIL 17 15 1.1 108 Na K Ca P Cl CRP 147 4.4 9.2 3.4 3.61 WBC Hb Plt MCV Hct 6.9K 12.9 205K 92 39.2% Seg Band Lymph Aty-Lym PT APTT 76.7% - 14.4% 11.6 27.8

Lab data CEA CA199 CA125 CA153 SCC 4.868 5.4 27 5.1 0.17

Tentative diagnosis Anterior mediastinal tumor, suspected thymic cancer.

Plan Tumor excision. Admitted to SICU after the operation.

OP finding

Remove CVP and Chest tube. Coarse breathing sound No fever. Wound pain Coarse breathing sound. Remove one chest tube Remove CVP and Chest tube. No discomfort was told. extubation was performed smoothly in SICU 9/7 9/9 9/12 9/11 9/8 9/6 Stable vital signs. Coarse breathing sound Flatus passage(+) Sputum(+) Severe wound pain Ambulation: good Clear breathing sound. MBD the next day.

Pathology report Pathologic diagnosis: Bronchial cyst. Specimen : yellow fatty soft tissue, 7x5x3 cm Many cystic spaces in a adipose tissue background. The cystic spaces are mainly lined by ciliated columnar epithelium with foci of goblet cell differentiation. A few thymic tissue can be identified.