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鉴别诊断Veidenheimer 医师:本例63岁妇女患慢性骨关节炎和类风湿关节炎,肥胖。入本院前两天,患者曾在家中跌倒不能站起先入另一间医院诊治。尔后以败血症转入我院。患者表现为发热,白细胞计数升高,革兰阴性菌血症,臀部大疱病变之吸出液查到革兰阳性杆菌,以及广泛的皮下气肿,累及双下肢、右臀、右侧躯干,包括右侧胸壁和锁骨上窝区。一开始讨论本例时,我就立即注意到病情的关键所在。最引人注目的体征是出现在双下肢、右臀和右侧躯干的捻发音。皮下气肿最明显的部位是个巨大的紫色皮区,直径40cm,布满整个右臀。患者在另一
Differential diagnosis Veidenheimer MD: A 63-year-old woman with chronic osteoarthritis and rheumatoid arthritis, obesity. Two days before entering the hospital, the patient fell home at home and could not stand up for treatment in another hospital. Subsequent to sepsis into our hospital. Patients showed fever, increased leukocytosis, Gram-negative bacteremia, aspiration of gluteal bullous lesions, gram-positive bacilli, and extensive subcutaneous emphysema involving the lower extremity, right hip, and right torso, including Right chest wall and supraclavicular fossa. When I started my discussion of this example, I immediately noticed the key to the condition. The most striking signs are the twisting sounds that appear on the lower extremity, right hip, and right torso. The most obvious site of subcutaneous emphysema is a huge purple skin, diameter 40cm, covered the entire right hip. Patient in another