Lung center Darmstadt

Radiology –Darmstadt
Academic teaching practice for radiology at the university hospital Heidelberg
Radiology Dramstadt. Grafen street 13,64283 Darmstadt
Mr.
Dr. med. K. Kneser
FA for the inside medicine
Dieburger str. 22
64287 Darmstadt
08.011.2016
Pat. ID: 482742
Pat: Abdelkhalek, Elmetwually, born 28.11.1968
From 64287 Darmstadt, Rehkopfweg 14
Dear respected our college,
We thank you for the friendly referral of the above mentioned patient
16 lines CT of the thorax native including HR technique from 08.11.2016
Technique: Standard, in addition with MPR
Clinical information and justifying indication according to RoeV
Unclear pulmonary fibrosis, quite short history
The findings
Preliminary images of the pre-CT from 15.05.2016 and 24.08.2016 on laser film. Slightly inhomogeneous stretosis hepatis. Otherwise, the upper abdominal organs included in the native partial incision are inconspicuous. Thyroid gland does not increase in size symmetrically. Rumf and and axial skeleton, apart from degenerative changes of the thoracic spine, without suspensions. No suspicious osteolysis. No indication of fractures. no medial-sternal or axillary lymphoma. Hery and medial stinal leadership structures downright. Diffuse interstitial lung disease with predominantly fine reticular, partly milk-gel-like character, something also emphasizes the interlobular septa. Map-like proportions of milk-gel-like turbidity and apical partial consolidation. Detection of traction bronchiectasis in all lung sections. These changes are emphasized apically. Here also partially infiltrative character, no honeycombing. no stigmata for a granulomatous underlying disease / sarcoidosis.

The evaluation
Diffuse interstitial lung disease with fibrosing character and traction bronchiectasis in all lung sections, features of a UIP are present, but atypical of the somewhat apical emphasized distribution and the absence of a honeycomb pattern. DD most likely after exogenous allergic alveolitis or other inhaled noxae. retrospective in the course of this initially predominantly milky-glass-like infiltrative component, peribronchial and centrilobular stresses (may 2016), then increasing transition to fibrosis with traktionsbronchiektasen, the latter also progressive since August. Anamnesis of an exoposition with pet birds in 2015, since then complaints.
The findings report and recordings on CD were given.
Interdisciplinary findings meeting with pneum board on the same day,
Best regards
Prof. Dr. med. J. Biederer
The specialist doctor for Radiology

  Lung center
Darmstadt
Prof. Dr. Med. Steinmetz
Dr. Med. Forster
Dr. Med. Knester
Internal medicine, pneumology and sleep medicine
OP- Report from: 10.11.2016
Patient: Abdelkhalek, Elmetwually, born 28.11.1968
Diagnose: rigid bronchoscopy with BAL and Kryo- TBBn S8, S9, S4, S3 re.
Operation: interstitial lung disease DD EAA/ NSIP/ IPF
Initiation of general anesthesia by the anesthesia department. intubation with the 12mm tracheoscope.
flexible Ausspeigeln, Central Tracheobronchialsysten downright. lavage for microbiology and cytology. BAL ML (160 / 120ml, clear)
Finally cryo-TBBn on S8, S9, S4 and S3 re. No rebleeding.
Anesthesia delivery and extubation by the anesthesia department.
The evaluation
M.E or EAA/NSIP
Procedure: Vital sign control, Rö thorax with question pneumothorax re. around 11:30,
Handover to the doctor
Dr. Med. Konrad Knester
  Lung center
Darmstadt
Prof. Dr. Med. K. O. Steinmetz
Dr. Med. A. Forster
Dr. Med. K. Knester
Dieburger Str. 22
64287 Darmstadt
Telefon 0651/428760
Alico hospital – Dieburger Str. 31- 64287 Darmstadt
Mr.
Abdelkhalek, Elmetwaually
Rehkopfweg 14
64287 Darmstadt

Alico hospital
Dieburger Str. 31
64287 Darmstadt
Telefon 06151/4020
Dear colleague,
We report on your patient, Mr. Abdelkhalek, Elmetwaually ( 28.11.1968) , residing in 64287 Darmhaft, Rehkopfweg 14, which was in our inpatient treatment from 10.11.2016 to 11.11.2016
Actual Diagnosis:
interstitial lung disease DD EAA/NSIP/IPF
Pre-existing disease:
art. Hypertension
Anamnese
The inpatient admission took place for the planned bronchoscopy of interstitial pulmonary disease. There is a glucocorticosteroid therapy with currently 60mg prednisolone since may 2016, among which it has come to a pronounced myopathy.
Physical examination
47 years old patient, 186 cm, 100.0 kg reduced general condition, normal nutritional status with clear consciousness. Pulmo and Cor without pathological findings, RR 130/70 mm Hg, pulse 90 / min. Abdominal examination and neurological examination were unremarkable.
Endoscopic and sonographic findings:
Rigid bronchoscopy with BAL and Kryo- TBBn S8, S9, S4, S3 re.
Central tracheobronchial system. Lavage for microbiology and cytology. BAL ML (160/120 ml, clear). Finally cryo-TBBn on S8, S9, S4 and S3 re. No rebleeding.
BAL: Cell number 8Mio./ml., Alveolar macrophages 96%, neutrophilic 3%
Evolution: M.E most likely EAA / NSIP
EKG:
HF 87/min., Sinushythmus, linkstyp, no ERBS
Sonography abdomen:
Pronounced meteorism, fatty liver, LV unremarkable, V.portae hepatopathy, pancreatic corpus inconspicuous, head and cauda superficial, kidneys of normal size, no urinary retention, regular shape, spleen normal size, regular shape, large vessels partially air-superimposed, vena cava breathable, no pleural effusions , no pericardial effusion, no free fluid.
1- and 2-D echocardiography:
(B, M, Duplex, PW, CW): normal left ventricular systolic and diiastolic function. No evidence of relevant pulmonary hypertension. Received RV function. Ao 30mm, LA 35mm, EA, Ao DPsyst 4mmHg, RV LV, no Ti, TAPSE 26mm, PA-AcT ca, 70mesec.
Histology:
Later
Course and assessment:
We took Mr. Abdelkhalek for further clarification of an interstitial lung disease. On November 10, 2016, the bronchoscopy with PE extraction took place. After a brief routine monitoring on our multi-disciplinary intensive care unit, the presentation took place on a peripheral station. A radiographic follow-up excludes pneumothorax.
After complications, we were able to release Mr. Abdelkhalek on November 11, 2016 in her further outpatient care. After receiving the (histo) findings, the patient introduces himself in our practice to discuss these. With a fever increase of over 38 degrees Celsius over 24 hours is an oral antibiotic therapy with z.BSp. Tavanic 750 mg 1-0-0 recommended.
We dismiss the patient in their further treatment. Presentation date on 16.11.2016 is planned.
The last medication:
Calcitron Cap (piece): 1-0-0-0 (piece)
Lasilactone 50 mg/20mg (spironolactone 50 / furosemide 20) (piece): 1-0-0-0 (piece)
Pantoprazol (PAntozol 40 Kps. ) Piece : 1-0-0-0 (piece)
Prednisolon (Prednisolon 20 mg Tbl. )(piece): 2-0-0-0 (piece)
Azathioprine 50 mg:1-0-0