Exertional fatigue
A 32-year old male, presented because of exertional fatigue. His complaints started 2 months ago with an occasional dry cough, and he progressively started to get easily fatigued during regular daily activities and concomitant dyspnea. He lost 6 Kg for those few months. He denied any other symptoms. Chest X-ray was done which shows diffuse "honeycomb" appearance bilaterally with some slight opacities on the right upper lobe and left lower lobe. His Past history was unremarkable except smoking. Family history is positive for lung cancer in his grandfather. The physical examination was unremarkable, except the area of faint inspiratory wheezing in the projection of the right upper lobe. The laboratory analyses showed the next pathological values: Ly. 0.61, ESR 32, CRP 17.7, D-dimer 0.86, creatinine 113, uric acid 490, total protein 92 (albumin was 40), Ca 2.75, alkaline-phosphatase 143. The patient was admitted to the hospital for further investigations. What is your impression of this case? What would be your further management plan? Interstitial lung disease of chronic course?
Cxr chest bilateral honey comb appearance with parahilar opacities Hyperinflatted lungs Raised CRP, ESR, D -dimer Highly raised Creatinine, uric acid & calcium level CRF with possibility of Ca Lung Dialysis LMWH Antibiotics Inj Erythropoeitin, see Hb O2 support Diuretics Judicial iv crystalloids Further refer to consultant
ILD with secondary infection ? Usual Interstitial Pneumonia ( UIP ) Suggest HRCT, Sputum for AFB, eosinophils, silica , PFT , bronchoscopy and lung biopsy . Advise Smoking to be discontinued Avoid inhaled pollutants Lung expansion exercises Inhaled beta agonists and steroids regularly . Theophylline
IT'S A..CASE OF.. ? ILD .. ? PTB .. ? MALIGNANCY.. WITH.. ? CKD .. CREATININE INCREASED.. NEED'S CLINICOPATHOLOGICAL EVALUATION WITH.. SPUTUM STUDY.. HRCT.. BRONCHOSCOPY.. BSR HBA1C.. KFT..
He looks to be a c/o ILD H/o smoking But raised levels of sr creatinine and uric acid need to r/o Ckd and diabetes Ca 2.75 definitely to keep in further analysis of malignancy
Copd Emphysema Look like ILD Seroflo & Duoline rotacap inhalation through rotahaler
Either ILD duo to smoking Or Bronchial carcinoma Rull out kochs
SUGGESTIVE OF I. L. D WITH SUPERADDED INFECTION..
Possibly ILD Needs HRCT thorax to confirm and typing.
? ILD.. ? PTB.. ? CARCINOMA.. HRTC.. BRONCHOSCOPY..
Bilateral involvement + Bronchial prominent ring lesions. This can be Bronchitis or Bronchiectasis or Bronchopneumonia. Constitutional symptoms and inquiry into the nature of sputum helps narrowing down the diagnosis
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