Gutierrez

Patient is a 62/M from Sta. Rosa, Laguna Cir=ty R handed, Roman Catholic, former food vendor
(pastries)

HPI: 1 month PTA, patient consulted at a Community Hospital in Sta. Rosa for right jaw, right
shoulder and right nape pain (sharp 4/10), an alleged X-ray and ECG was done and was allegedly
unremarkable, was given celecoxib 200 mg BID and was discharged with said partial relief of pain.
3 days after, symptoms persisted with additional (+) inc abdominal girth (+) RUQ and RLQ crampy
abdominal pain with an NRS of 5/10, and decreased stool caliber was noted. This prompted consult
at Binan – Perpetual Medical Center.Chest CT-scan was done showing, linear densities in the superior
and posterior segments of both lower lobes. Minimal Right sided pleural effusion. Several non-
calcified paraaortic lymph nodes, the largest measuring 1.5 x 0.7 cm, Peripherally enhancing
hypodense foci: Right sternocleidomastoid area, Retromandibular area, retromanubrial area,
Retrosternal area, R upper lobe, 1’st intercostal space: 3.6 x 1.4 x 2.9 cm, Peripherally enhancing
hypodense focus is also seen in the paraaortic area from the arch down the mid descending thoracic
aorta with associated fat strandings, The Liver is prominent in size measuring 14.9 cm (MCL).
Peripherally enhancing hypodense foci in the right pectoralis major and minor muscles, Right
sternocleidomastoid muscle, retromanubrial area, retrosternal area extending to the ant.
Mediastinum, and anterior segment of the R upper lobe, 1’st left intercostal space and right psoas
muscle; considering multifocal abscess formation and peripheralyy enhancing hypodense focus in
the paraaortic area from the arch down to the mid descending thoracic aorta; considering
mediastinitis. The assessment then was: Multifocal Abscess formation: Mediastinitis; Ileus: Jaundice
secondary Sepsis, Community acquired pneumonia MR – resolved. During this admission patient was
noted to have 4x3 cm non tender moveable mass at mid axillary line at level of T2-T6, (+) grade 2
bipedal edema, patient was treated with Pip_Tazo 4.5g IV q8 hours then and was discharged against
medical advice due to financial constraints and subsequently consulted here at PGH. Hence this
admission.

A: Multiple Masses (Pectoralis, SCM, retromandibular, retrosternal, paraaortic area, R psoas muscle)
likely tuberculosis r/o malignancy
Gram (+) bacteremia
Jaundice, probably cholestatic from infection.
Chronic Assymptomatic hyponatremia, t/c SIADH from TB vs. paraneoplastic from malignancy.
Ileus Resolving prob. From infection r/o obstruction
Anemia 1) Chronic Disease 2) Nutritional 3) Acute Inflammation
t/c immunocompromised state
Oral Candidiasis.

HA-UTZ (PGH) Apil 15, 2019

Impression: Psoas focus, as described for which an abscess formation is primarily considered. A
fairly-defined heterogenous complex focus with internal medium level echoes and posterior acoustic
enhancement is seen in the right psoas, measuring approx.. 11.5 x 4.5 x 4.6 cm (cc x W x AP), with an
approx. volume of 123cc.

Abdominal CT- scan provisional reading (PGH) 17 April 2019

There is significant interval inc in the size of the previously noted large, rim-enhancing, hypodense
focus, thickening the mid to distal third of the right psoas muscle. It now measures approx.. 11.0 x 3.1
x 5.3 cm (CCxWxAP) with estimated volume of 80cc. Small air pockets are noted in the non-
dependent portion of the said hypodense focus.