1. 호흡 곤란을 주소로 내원한 44 세 여자 환자 호흡기 내과 R1 이지훈 / Prof. 박명재

2. Chief Complaint Dyspnea on exertionOnset) 6 개월 전 Present Illness 44 세 여자 환자, 평소 특이 병력 없던 환자로 6 개월 전부터 점차적 으로 심해지는 활동 시 호흡 곤란에 대해 primary clinic 에서 시행한 chest x-ray, chest CT 검사상 이상 소견 관찰되어 이에 대한 추가 검사 위해 호흡기 내과 외래 내원함. Patient Number12313219 Gender/AgeF/44 Date2012.11.29

3. Past Medical History DM/HTN/Tb/Hepatitis(-/-/-/-) Operation History(-) Pneumothorax(+) : 7~8 년 전 Pneumothorax(+) : 7~8 년 전 Family History None Personal History Smoking(-)/ Alcohol(-)

4. General : fatigue(-) fever(-) chill(-) weight loss(-) Skin : rash(-) pigmentation(-) Itching(-) Head & Neck : headache(-) stiffness(-) Eye & ENT : sore throat(-) periorbital edema(-) dyspnea on exertion(+) Respiratory : cough(-) sputum(-) dyspnea on exertion(+) Cardiac : chest pain(-) orthopnea(-) palpitation(-) Gastrointestinal : A/N/V/D/C(-/-/-/-/-) abdominal pain(-) dysphagia(-) Urinary : dysuria(-) hematuria(-) oliguria(-) Musculoskeletal : arthralgia(-) weakness(-) Nervous : syncope(-) seizures(-) dizziness(-) stroke(-)

5. 1.General appearance - Consciousness : alert - Not so ill looking appearance 2.Skin - rash (-), pigmentation(-), petechiae (-) 3. Head & Neck - No neck vein engorgement - No cervical lymph node enlargement 4.Eye/ENT - Isocoric pupil c PLR(++/++) - PI(-), PTH(-/-)

6. 5.Thorax - Clear breathing sound without rale - Regular heart beat without murmur 6. Abdomen - Soft & flat abdomen - Normoactive bowel sound - No tenderness, No rebound tenderness 7.Back/ Extremity - No CVA tenderness - No pretibial pitting edema 8. Neurology - No flapping tremor

16. #1. Progressive dyspnea on exertion #2. Multiple cystic lesions on both lung fields #3. History of pneumothorax

17. A) r/o Lymphangioleiomyomatosis, most likely r/o Alpha-1 antitrypsin deficiency r/o Pulmonary Langerhans cell histiocytosis P) Pulmonary function test If needed, surgical biopsy

21. Salbutamol Tiotropium

22. Pregnant History 26 세 : 1 st delivery 29 세 : 2 nd delivery ※ 임신 시 호흡기 증상 악화 없었음.

29. Spirometry

30. #1. r/o lymphagioleiomyomatosis, most likely