一位70歲男性具胸痛及呼吸喘表徵之創傷性膿胸

A 70-year-old Male with Traumatic Empyema Presented with Symptoms of Chest Pain and Dyspnea

老年病患當同時有胸痛及呼吸喘症狀時，需要考慮到各種急症的可能性，若加上非典型的臨床表徵，更可能造成一線醫療人員鑑別診斷的困難度。案例是一位70歲男性，此次因胸痛及呼吸喘入院，初步臆測肺炎及肋膜積水，但亦不能排除其他急症之心肌梗塞、肺栓塞或主動脈剝離的可能性。經由理學及影像學檢查來排除上述急症之診斷，進而偏向肺炎及肋膜積水診斷的可能性。住院期間，病患出現發燒及白血球增高表徵，但細菌培養皆為陰性，且經驗性抗生素使用之下症狀未獲得改善，因考量入院前有創傷史，經胸腔超音波檢查併穿刺引流管放置，及胸部電腦斷層等詳檢確認膿胸診斷，最終以胸腔鏡手術介入治療，同時病理組織確認為第三期膿胸。病患住院中接受手術及抗生素輔助治療，並搭配呼吸訓練之後，症狀改善出院。因此當遇到案例有胸痛合併呼吸喘，加上其他危險因子如：老年人、長期咳嗽、慢性腎臟疾病及胸部創傷史等，必須將創傷後膿胸列為鑑別診斷，以免錯失診斷及治療先機。

 

Geriatric patients presenting simultaneously with chest pain and dyspnea require careful evaluation for potential medical emergencies. Atypical symptoms can complicate the differential diagnosis pro-cess. We present the case of a 70-year-old man who was admitted with chest pain and dyspnea. The initial differential diagnosis considered included pneumonia, pleural effusion, myocardial infarction, pulmonary embolism, and aortic dissection. During his admission, he became pyrexial with leuko-cytosis, and all his cultures (blood, sputum, pleural effusion) came back negative. He did not respond to empirical antibiotics. Due to a history of trauma, empyema was suspected. Stage III empyema was further diagnosed by imaging, thoracoscopy and pathological tissue examinations. Surgery, antibiot-ics, and breathing exercises were provided and led to a complete recovery. Taking into account other risk factors such as elderly age, chronic cough, chronic kidney disease, and a history of chest trauma, it is essential to consider empyema as a differential diagnosis for proper and instant treatments.