Concluded Case

What is the main stay of diagnosis and treatment tactics

X., 39 years old, turned to the maternity hospital with complaints of repeated prolonged bleeding from the genital tract, an increase in body temperature to 39 degrees. Anamnes morbi. According to the words, these complaints appeared 6 days ago, he connects with the missed pregnancy, which was 3 months ago. Anamnes vitae Heredity is not burdened. The operation denies. Denies tuberculosis, hepatitis, sexually transmitted diseases. There were no blood transfusions. Denies bad habits. Allergic history is not burdened. Menses from the age of 15, were established immediately, for 5-6 days, after 28 days, painless, not heavy. There were 4 pregnancies, 3 of which ended in normal urgent delivery without complications. Status objectivus. Condition upon receipt of moderate severity, skin and visible mucous pale. Pulse 88 per minute, rhythmic, satisfactory filling. Temperature 38 ° C. HELL 120/70 mm Hg From the lungs and heart pathological changes were not detected. The liver and spleen are not palpable. Status localis. On palpation of the abdomen, an enlarged uterus is determined. Inspection in the mirrors. External genitals and vagina without features. When viewed with the help of mirrors, cyanosis of the mucous membrane of the vagina and cervix is noted. In the vagina, the formation of a dark cherry color, bleeding. The uterus is enlarged, its surface is tuberous, and the consistency is heterogeneous. determined increase on both sides of the uterus Ultrasound OMT data: there is an increase in the size of the uterus, absence of the fetus and the presence of homogeneous, fine-grained tissue in the uterus, luteal cysts of both ovaries. In urine tests, a high level of hCG is determined. Trophoblastic beta-globulin 94% Chest x-ray: Multiple, rounded foci of metastatic lesion in the lungs, effusion in the pleural cavity. Questions: 1. What is your preliminary diagnosis? 2. What is your treatment tactic?

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Concluded answer

Ca uterus Malignant chest metastasis Possible incomplete abortion

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Ca uterus Malignant chest metastasis Possible incomplete abortion