1. Impression Initial plan
1. Endobronchial Tb
Initial plan
1. chest CT
2. bronchoscopy
3. Tb culture, AFB stain, MTB PCR
4. quantiFERON-gold

2. Chest CT

3. Chest CT

4. Rt bronchus intermedius
brochoscopy (2/15)
Rt main bronchus
Rt bronchus intermedius
Mass 직하방

5. brochoscopic biopsy (2/15)
bronchial fluid
AFB stain (-)
AFB stain culture (-)
MTB PCR (-)
sputum
MTB PCR (-)
MTB PCR hybridization (-)
brochoscopic biopsy (2/15)
bronchial mucosa showing caseous necrosis and granulomatous inflammation consisted of epitheloid hystiocytes and lymphocytes with Langhans giant cell. No evidence of malignancy is seen.
Tuberculosis, consistent with,
Special stain finding: A.F.B(-)
quantiFERON-gold (2/16)
positive

6. Case 3 기침과 가래를 주소로 내원한 50대 남성 Chief complaint Present illness
adm
Chief complaint
cough o/s ) 2개월 전
Present illness
9년 전 폐결핵 진단받고 보건소에서 약 복용 후 완치판정 받은 자로 2개월 전부터 기침 지속되어 촬영한 chest CT 에서 endobronchial Tb 의심되어 정밀검사 위해 내원
Past medical history
DM/HTN/Tb/hepatitis (+/+/+/-)
DM: 20년 전부터 medication, 현재 metformin+insulin
HTN: 1년전 medication, unstable angina: CAG & PTCA(prox.LAD)
Personal history
Smoking ( + ): 30 PY Alcohol ( + ) : 3회/주, 소주 1~2병

7. Review of System Physical Examination
General fatigue (+) febrile sense (-) chilling (-) myalgia (+)
weight loss(-) night sweating (-)
Head & Neck headache(+): 현재는 경감 nasal obstruction(+) rhinorrhea(+)
Respiratory cough (+) sputum (-) tachypnea (-)
Cardiac chest pain (-) palpitation (-) orthopnea (-) DOE(+)
Physical Examination
Vital sign /80mmHg- 76/min- 24/min-36.5’C
General alert mentality
not so ill looking appearance
Thorax clear breath
regular heart beat withour murmur

8. Initial lab finding
CBC/DC /mm² g/dl – 42.4 %- 262K (seg : 77.8%)
aPTT /34 sec PT(INR) S100C13.3 (1.00 )
Chemistry
TB/DB /0.08 mg/dL AST/ALT 29/23 U/L
ALP/GGT 81/25 U/L protein/alb 6.2/3.1 g/dL
LD/CK /54 U/L BUN/Cr 13/0.6 mg/dL
Na/K/Cl 134/3.9/95 mmol/L
UA RBC 0-1/HPF WBC 0-1/HPF

9. Chest X ray

10. Chest CT

11. Impression Initial Plan
1. endobronchial tuberculosis
Initial Plan
1. Tb culture, AFB stain, MTB PCR
2. bronchoscopy
3. quantiFERON-gold

12. Clinical course Plan * sputum AFB stain (-) AFB stain culture(-)
MTB PCR (-)
cytology : within normal limit
* endoscopy
: no endobronchial lesion
* quantiFERON-gold
: positive
Plan
HERZ 시작