The Missing Piece

A CLINICAL PROBLEM-SOLVING article by Kathryn Robertson from University of Colorado Health Sciences Center in Denver.
A 21-year-old man presented to the emergency department after a 2-day history of increasing pain in the right lower quadrant. He had had exertional dyspnea and a cough productive of scanty yellow sputum for a month.
He had previously been employed as a sushi chef, but he had not worked for 3 months. He had not ingested raw shellfish but had prepared raw crayfish and crab. 4 years before presentation, he had spent 3 months visiting relatives in rural areas of South Korea.
Laboratory analysis revealed peripheral blood eosinophilia and a chest X ray showed moderate-sized, bilateral pleural effusions.
One of the most effective strategies involves pattern recognition, in which the clinician breaks the case down into manageable pieces and compares features of the current case with ones he or she has seen in the past. New cases are then recognized as similar or identical to old ones that have already been solved. In the case under discussion, the clinician focused on two patterns of disease with which he was familiar: abdominal pain and respiratory disease.

今回は、폐흡충(肺吸蟲)でした。