Haemoptysis, breathlessness and chest pain in a 46-year-old man
A 46-year-old man came to the outpatient department with complaints of progressively increasing right-sided chest pain accompanied by tenderness since six months, which even disturbed his sleep. Since the past three months he also noticed breathlessness which has progressively increased and since one week he is breathless even at rest. A week ago, he noticed bright red blood in his sputum. Since then, he has been coughing out fresh blood, about a quarter-cupful a day. On questioning, the patient said that he was a heavy smoker who smoked 30 cigarettes a day for the past 27 years. He worked as a clerk in an office. There was no history suggestive of contact with a tuberculous patient. His family members too were healthy and well. He had no past history of diabetes mellitus or hypertension. On examination, the patient appeared breathless with a respiratory rate of 28 breaths per minute. His pulse rate was 108 beats per minute and the blood pressure was 102/68 mmHg. The trachea was shifted to the left side. There was gross tenderness over the right side of his chest, both anteriorly and posteriorly. Chest wall movements were diminished on the right side and there was a dull note on percussion over the entire right hemithorax, both anteriorly and posteriorly. On auscultation, air entry was absent over the right mid-zone and lower-zone and tubular bronchial breath sounds were heard in the right interscapular region. A chest radiograph was done. (copied from article)
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