Cough & Chest pain

Chief Complaint A 68-year-old male presented with non-productive cough & chest pain, mild headache, malaise, and SOB. He also complained of weight loss. Vitals BP: 125/85 mmhg, Resp rate: 18 breaths per min, Pulse: 76 bpm, Temp: 98.4 degree C. Investigations WBC: 8.2 k/mm3, Hb: 12.5 g/dL, hematocrit 36% platelet count of 210 k/mm3. Sodium 130 mmol/L, potassium 4.5 mmol/L, chloride 102 mmol/L, bicarbonate 25 mmol/L, urea nitrogen 43 mg/dL, creatinine 1.5 mg/dL, calcium 9 mg/dL. BNP <10 pg/mL. CT chest was done which was suspicious for pulmonary embolus. CTA shows 1.7 cm soft tissue nodule upper right lower lobe. Treatment What management plan should be done?

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Though CT chest if showing suspicious of pulmonary embolism, CT angiography is not showing any pulmonary embolism, CT angiography need to be relied on for confirmation of pulmonary embolism Please rule out COVID 19 by doing RT PCR Check for pulmonary tuberculosis by doing Sputum for AFB

As CT chest is suspicious of Pulmonary embolism and CTA shows 1.7 cm sodt tissue,nodule right lower lobe - confirm Pulmonary embolism by A ventilation- perfusion scan or by Pulmonary angiography. Once confirmed- thrombolysis is indicated by use of alteplase ( tPA )

Consider ICS LABA combination. Evaluate for active PTB or malignancy.

Obviously PTB/malignancy

Thanks Dr. Dinesh Gupta, Dr. Sandeep Ghodeker
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POSSIBLY KOCH'S DD MALIGNANT CHANGES NEEDS FURTHER. EVALUATION

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