Dr. Valerie E. Stone: May we review the radiologic
studies?
Dr. Victorine V. Muse: The chest radiographs and
CT scans of the chest obtained during the previous
admission showed bilateral calcified pleural
plaques, pulmonary fibrosis thought to be secondary
to asbestosis, and enlarged mediastinal lymph
nodes, all of which had been present and unchanged
for at least 1 year. Abdominal and pelvic
CT scans showed no abnormalities at that time.
The chest radiograph on the current admission
showed progressive lower-lobe consolidation
and ground-glass opacities superimposed on the
previously described findings.
Victorine V.ミューズ博士：前の承認の間に得られた胸の胸部X線検査およびCTスキャンは相互の石灰化された肋膜ブローチ（石綿症に対して従属的であると考えられる肺線維症）を示して、縦隔リンパ節を大きくしました。そして、その全ては少なくとも1年の間存在して不変でした。
腹部・骨盤のCTスキャンはその時に異常を示しませんでした。現在の承認中の胸部X線検査は、以前に記述された発見物の上に置かれた進行中の下部耳たぶ合併およびスリガラス状の不透明部を示しました。
ビクトリーネ・ V・ミューズ医師: 前回の診療の際の胸部レントゲン写真とCTスキャン写真には、アスベストシスの転移と考えられる左右相称の胸膜プラークと肺線維症、肥大化した後縦隔リンパ節が見られ、これらは少なくとも過去一年間に変化なく存在した。胴部および骨盤部のCTスキャン結果は、異常が見られなかった。今回の胸部レントゲン写真に見られる、肺の下葉の境界不鮮明な陰影とスリガラス状の陰影は、前回の写真と重ねた結果、進行性であることがわかる。
A repeat CT scan
of the chest on this admission (Fig. 1A) showed
no change in the findings in the chest but disclosed
multiple low-attenuation lesions throughout
the liver that had not been present previously
and were confirmed on CT scans of the abdomen
and pelvis (Fig. 1B).
Dr. Stone: This elderly man with a history of
asbestos exposure, heavy smoking, and diabetes
mellitus presented with fatigue, weight loss, malaise,
mediastinal lymphadenopathy, and pulmonary
infiltrates superimposed on pleural-based
abnormalities that had remained stable for a period
of 9 to 15 months.
The current admission was
prompted by the recent onset of fevers, failure to
thrive, and odynophagia; evidence of oral and
esophageal candidiasis was found, and multiple
lesions in the liver were seen on CT imaging.
This patient is 81 years of age and has longstanding
diabetes and recurrent episodes of congestive
heart failure. Ischemia and myocardial
dysfunction resulting in heart failure could be a
subtle contributor to his generalized malaise,
weight loss, and failure to thrive. Although cardiac
disease is common in the elderly, this patient
had a normal electrocardiogram and normal cardiac
markers, making this diagnosis unlikely.
Because of the
patient’s difficulty swallowing, upper gastrointestinal
endoscopy was performed. May we review
the endoscopy findings?
Dr. Brenna C. Bounds: Endoscopic examination of
the esophagus (Fig. 2B) revealed extensive, confluent
white plaques throughout its length, with
a cobblestone appearance, which is diagnostic of
esophageal candidiasis. The appearance of muscular
hypertrophy seen on barium swallow (Fig.
2A) was in fact large numbers of candida plaques
that were present all the way from the mouth to
the esophagogastric junction.
The diagnoses of esophageal
candidiasis and non-Hodgkin’s lymphoma do not
guarantee that the patient has no other diagnoses.
ブレンナ C.バウンズ博士:玉石外観で、食道（図2B）の内視鏡検査はその長さを通して広範囲な、合流する白い斑を露わにしました。そして、それは食道カンジダ症の診断です。バリウム一飲み（図2A）に関して見られる筋肉肥大の出現は、実際のところ、口から食道胃接合部までずっと存在した多数のカンジダ属飾り額でした。
食道カンジダ症と非ホジキンリンパ腫の診断は、患者が他のいかなる診断も受けていないことを保証するものではありません。
