Cough, haemoptysis and increasing breatlessness in a 55-year-old cachexic male
A 55-year-old man came to the outpatient department with complaints of cough, purulent expectoration and breathlessness off and on since the past three years. Since the past two weeks, he has noticed blood in his sputum each time he coughed. He also complains of weight loss of 4 kg accompanied by loss of appetite, over the past three months. He gives history of pulmonary tuberculosis three years ago, for which he took treatment for six months. On examination, the patient appears cachexic. He is tachycardic and tachypnoeic with a pulse rate of 96 beats per minute and a respiratory rate of 32 breaths per minute, respectively. He is dusky in appearance and his blood pressure (BP) is 134/82 mmHg. On examination of his chest, the left hemithorax appears to be “flattened” as compared to the right side. The trachea is shifted to the left side and the left hemithorax also moves significantly less as compared to the right. On percussion, there is a dull note over the entire left side of the chest both anteriorly and posteriorly, while a normal resonant note is heard over the right side. On auscultation, there is diminished air entry over the entire left hemithorax with tubular bronchial breath sounds heard over the left infraclavicular and interscapular regions. Vocal resonance is diminished over the entire left hemithorax except in the left infraclavicular and interscapular regions, where it is increased. Auscultatory findings are normal over the right side. A chest radiograph is done (Figure 1). (copied from article).
Crofton and Douglas’ Respiratory Diseases. 5th ed. Blackwell Science; 2008.