Pneumonia Case Discussion,Xu Changqing Address: Hangzhou City, Wenzhou Road No. 16 Email：cute1998,2019/9/26,1,The condition of the patient,1,Yu Jinyu, male, 64 years old, 2, 5 months ago, the patient started coughing without a cause, coughing white sputum. More severely: fever with a temperature of 38 . In the local community hospital he was treated for 2 days without any improvement. So he came to our hospital to be admitted with pulmonary infection.,2019/9/26,2,The condition of the patient,3, Examination of pulmonary CT: Double pneumonia lesions, for anti infection, stop cough and phlegm and other treatments. The temperature dropped gradually and the condition improved. 4, The patient was careless as to inhale food one month beforehand, then the patient began to cough, sputum, and have fever. After being hospitalized, feeding through a nasogastric tube , anti infection, and phlegm treatment. The condition improved. Multiple hospitalizations.,2019/9/26,3,The condition of the patient,4, 1 day ago, the patients condition worsened. He was admitted to the hospital for further treatment, quasi “Pneumonia, Parkinsons disease,“ admitted to our department. Has Parkinsons disease history for 5 years.,2019/9/26,4,The condition of the patient,Physical examination: P 90 / R 19 / BP 119/72mHg T 36.6. Clear consciousness, bed rest, nasal feeding. Skin and sclera without yellow dye, no lips cyanosis, a soft and not swollen superficial lymph node of neck, no jugular vein enlargement, tracheae, no chest deformity, the intercostal space without broadening, double lung breathing symmetry, no change, fremitus without change, bilateral percussion sound, two pulmonary respiration crude and obviously, no rales or rhonchi; heart has no enlargement, heart rate 90, the law is neat; the abdomen is soft, complete abdomen tenderness, no rebound tenderness, below liver lienal costal region without palpable mass, renal area without percussion pain; lower extremities edema, neurological examination: limbs adverse events, activities joint degree is limited, muscle tension increased, strength can not check.,2019/9/26,5,The condition of the patient,2013-11-27 chest CT scan: comparison of the front sheet (2013-10-28) two pulmonary infections with bilateral pleural effusion was improved; hint at the thoracic inlet endotracheal nodular protrusion.,2019/9/26,6,Normal Chest CT Scan,2019/9/26,7,Lung: the right lung left lung two leaf clover. The pulmonary fissures (oblique fissure, horizontal fissure) boundary, appeared as low density pancivascular area or linear high density Pulmonary segments: the right lung left lung is divided into ten segments, eight segments. Segmental bronchus Tube in the lung, pulmonary artery segment center. Alveolar: filled with gas, so the lung showed low density shadow. Bronchus: filling gas, the tubular low-density “gas“ as the characteristics of. Pulmonary vascular: pulmonary intravascular filling blood, showed high density.,Chest CT scan of the patient 2013-11-26 2014-01-02,2019/9/26,8,Recurrent cough, fever Through a variety of antimicrobial treatment,The first, second, three line antibiotics Penicillin, Cephalosporinsseflosp:rnz, Fluoroquinolonesflrokwanlonz , Carbapenemsk:bpenemz etc.,There are 4 possibilities,1, The diagnosis is not clear 2, The older 3, Abnormal immune functions 4, Combined with various underlying diseases,2019/9/26,9,Thought,We can see, the patients condition has improved, but there is no obvious improvement in imaging, This is characteristic of aspiration pneumonia, pulmonary lesions difficult to absorb, Patients with low immunity, easy recurrence of pneumonia So, the patients with recurrent pneumonia, so he has to stay in the hospital,2019/9/26,10,Thought,Symptoms of bacterial pneumonia is larger, can be light weight, determined by the pathogen and host state. The common symptoms were cough, expectoration, or the original respiratory symptoms increased, and the emergence of purulent sputum or sputum with blood, with or without chest pain.,2019/9/26,11,Pneumonia disease range can have difficulty breathing, respiratory distress. Most of the patients have fever. Early signs have no obvious abnormity, serious person can have high respiratory rate, flaring of nares, cyanosis.,2019/9/26,12,Thought,Clinical manifestation,Pulmonary consolidation with typical signs, such as enhanced, fremitus percussion dullness and bronchial breath sounds, can also be heard and rales. Pleural effusion, ipsilateral chest percussion dullness, diminished breath sounds.,2019/9/26,13,Differential diagnosis,1, Pulmonary tuberculosis Many symptoms of systemic poisoning, afternoon fever, night sweats, fatigue, weakness, weight loss, insomnia, heart palpitations and other symptoms. X-ray visible lesions in the apical or supraclavicular, uneven density, dissipated slowly, and can form a cavity or intrapulmonary spread. Mycobacterium tuberculosis can be found in the sputum. The conventional antibio