60 yr male with cough and dyspnea since 10days with one episode of hemoptysis moderate amount known hypertensive and post cabg status on antiplatelets. d/d



Differential of this case.. Wegeners granulomatosis Bronchiectasis Tuberculosis Arteriovenous malformation bronchogenic carcinoma.. Send p-anca and C-Anca.. Sputum for AFB smear and bactec culture..

Causes of HAEMOPTYSIS 1.Bronchgenic carcinoma -smoker,age>40,recurrent non massive hemoptysis, weight loss. - physical finding(PF)-local chest wheezing. 2.Acute Pneumonia -Historical clue(HC) -acute fever,productive cough,pleurisy,rusty brown hemoptysis -PF -fever,focal coarse chest crackles,bronchial breath sounds. 3.Chronic bronchitis/Brochiectesis -HC- frequent copious sputum production, frequent 'pneumonias'. -Scattered , bilateral coarse crackles, wheeze,clubbing. 4.Heart Failure -HC-orthopnea, lower extrimity edema, history of valvular heart disease/CAD. -PF-Murmurs,S3,Loud S1 or P2. 5.TB,Fungal lung disease,Lung abscess - HC-Travel & exposure history, -PF- fever,coarse crackles,cachexia. 6.Vasculitis, hemorrhage syndrome -HC- subacute constitutional symptoms, hematuria,rash,arthralgias. -PF-diffuse chest crackles,mucosal ulcers, rash. 7.Pulmonary embolus -Acute dyspnoea , pleurisy. -PF-Hypoxia,Pleural rub,unilateral lower limb edema(DVT). 8.AVM/hereditary hemorrhagic telangiectesia - HC -Platypnoea,epistaxis,Family h/o similar signs & symptoms. -PF-Mucsal telangeictesias, orthodeoxia. in this case , possibility of heart failure, pneumonia & bronchitis is more. CXR is showing prominent bronchovascular markings & cardiomegaly. advised investigations- -Echo -BNP -sputum AFB,Fungal,cytology,routine & gram stain. -ANA/ANCA screen,anti GBM antibodies. if required FOB and Bronchial & Pulmonary arteriography.

the X ray also has numerous calcified bilateral intrapulmonary nodules( more on right), which may be due to - 1.infection-TB,histiplasmosis,chickenpox 2.Inhalation eg silicosis 3.CKD 4.Lymphoma following radiotherapy

there is some consolidation seen on right side.... it is close to hilum... ccf is less likely as left side looks pretty clear and even the bases are clear.... kindly mention the auscultatory findings... sputum culture, fever , looks like pneumonia...

it seems to be pulmunory congestion....as may be ccf....

D/D HOCF Bronciatasis Waiting granulomatosis

Pneumonitis with pulmonary congestion

pulmonary edema

consolidation in rt up lobe with cardiomegaly infective etiology more likely do sp afb gram stain culture do cbc pt inr

Clinical picture is of pneumonitis with haemoptysis aggravated by antiplatelets

hocm with ccf. hemoptysis agravated by anti platelet drug. .

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