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71歳男性の慢性進行性呼吸困難。8年間の受診を経ての診断イサカ
Chronic Progressive Dyspnea in a 71-Year-Old Man: A Diagnostic Ithaca After 8 Years of Consultation.
PMID: 32654735 DOI: 10.1016/j.chest.2020.02.003.
抄録
事例紹介:
71歳の元バス運転手（元喫煙者、20パック年）が8年前に慢性乾性咳嗽と陰湿な発症を伴う進行性労作性呼吸困難を理由に呼吸器科に初診で入院した。また、3年間で約20kgの体重減少と近位筋力低下を訴えていた。10年前に胃腺癌と診断され、胃の部分切除術と脾臓摘出術を行い、その後、化学療法を実施した。また，この患者は冠状動脈疾患を有しており，7年前に冠状動脈バイパスグラフト手術を受けた。冠疾患の経過の中で、Mantoux検査、5回のCTスキャン、CTガイド下生検、2回の気管支鏡検査、18F-フルオロデオキシグルコースPETスキャンを含む多くの診断的処置が行われたが、結論は得られなかった。この患者は、長期にわたる病状のために病院に紹介され、診断と治療を受けた。
CASE PRESENTATION: A 71-year-old ex-bus driver (ex-smoker, 20 pack-years) was admitted for the first time to the respiratory department because of chronic dry cough and progressive exertional dyspnea with insidious onset 8 years ago. The patient also reported weight loss of about 20 kg in 3 years and proximal muscle weakness. A decade ago, he was diagnosed with gastric adenocarcinoma and subjected to partial gastrectomy and splenectomy, followed by an unspecified chemotherapy regimen. Additionally, the patient has coronary disease and underwent coronary bypass graft surgery 7 years ago. In the course of his disease, many diagnostic procedures have been performed including Mantoux tests, five CT scans, a CT-guided biopsy, two bronchoscopies, and an 18F-fluorodeoxyglucose PET scan with inconclusive results. The patient was referred to the hospital to have his long-lasting condition diagnosed and treated.
Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.