kinsay doctor diha? unsay possible diagnosis ani nga patient?

[achibaby]

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KM, 21/f, G2P0(0010), admitted because of dyspnea

OB HISTORY: G1 - 2008, Spontaneous Complete Abortion 8 weeks aog
G2 - Present pregnancy - LMP April 18, 2010; EDC Jan 25, 2011
Menarche @12, regular, monthly interval
First sexual intercouse - 18y.o., 1 sexual partner. no contraceptives used
Non smoker, non alcoholic

HPI:

On 1st prenatal CU at 21 weeks aog
Fundic ht 20cms, FHT - 130/min, EFW - 500gms
Prenatal Labs: (+) UTI, started cefuroxime bid 7days w/c resolved the UTI
Pelvic UTZ - intrauterine pregnancy 21 weeks, live, singleton, cephalic, adequate, placenta, posterior grade ii, low lying

On 2nd Prenatal CU at 28 weeks aog
Patient complained of chronic cough for 2 weeks with occasional exertional dyspnea
On P.E.: 3x3cm right supraclavicular neck mass, slightly fixed and non-tender; decreased breath sounds on the mid to lower lung fields with occasional rales
CHEST X-RAY (PA view with abdominal shield): (+) mediastinal mass
UTZ (Thyroid): *****eral thyromegaly, consistent with Thyroid Parenchymal Disease with *****eral cervical lymphadenopathies
THYROID PANEL: within normal limits
Patient was referred for pulmonary service consult but did not comply.

On 3rd Prenatal CU at 31 weeks AOG:
Patient was admitted for severe dyspnea
On P.E.:
- multiple, non-tender, fixed mass at parieto-occipital areas
- neck: 5x5 cm, supraclavicular mass, (+) engorged neck veins
- decreased breath sounds on both mid to lower lung fields (+) minimal basal rales
- fundic ht 29cm; EFW 1500gms; FHT 130/min

ADMITTING LAB RESULTS:

- CBC: Hemoglobin 11.5; Hct 34.7; WBC 9.69; platelet 338,000
- SGPT: 84 U/L (N 5-50)
- LDH: 620.24 U/L (N 105-200)
- Direct Bb: 0.49 mg/dl (N 0-0.30)
- Uric acid: 3.94 mg/dl
- Crea 0.6 mg/dl
- K: 3.48 mmol/L
- Albumin: 23.82 g/dL (N 5-50)
- CXR: Mediastinal mass with moderate *****eral pleural effusion
- 2D-Echo: concentric left ventricular remodelling, adequare left systolic function, left ventricular diastolic dysfunction, grade i, moderate pericardial effusion without tamponade, ejection fraction = 71%
- UTZ (whole abdomen): multiple hypoechoic nodules of the spleen, *****eral hydronephrosis

Can please anybody help me?? what do you guys think? Sincere help would be much appreciated! Thank you!

[achibaby]

mods, i dont know if this is the right thread or maybe sa campus thread ni cya..e move lang nya palihug kung out of place ra kaayo thanks