Chapter

Case 26

John Stradling, Andrew Stanton, Najib Rahman, Annabel Nickol and Helen Davies

in Oxford Case Histories in Respiratory Medicine

Published on behalf of Oxford University Press

Published in print July 2010 | ISBN: 9780199556373
Published online November 2012 | e-ISBN: 9780191753299 | DOI: http://dx.doi.org/10.1093/med/9780199556373.003.026

Series: Oxford Case Histories

Case 26

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A 70-year-old man was admitted with severe dyspnoea, paroxysmal nocturnal dyspnoea and an unproductive cough that had progressed over 4 days. He gave a background history of minor exertional breathlessness over the last 6 months. A CXR 3 months previously had raised concern over a pulmonary nodule, and this had prompted a CT confirming multiple subpleural nodules, up to 16mm in size, along with borderline enlargement of mediastinal and axillary lymph nodes. An interval CT to assess any change was awaited at the time of his acute presentation. His background was of Type II diabetes mellitus (15 years duration), hypertension and mild chronic renal failure (recent urea 8.0mmol/L, and creatinine 151µmol/L). Systemic enquiry revealed intermittent nasal blockage, discharge and crusting. On examination he had a sinus tachycardia of 115, respiratory rate of 25/min, SaO2 of 26% on FiO2 0.6 and BP 105/70. JVP was not seen and there was peripheral oedema to both knees. Heart sounds were normal, and chest examination revealed reduced air entry at both bases and fine crackles to both upper zones.

Chapter.  1936 words.  Illustrated.

Subjects: Respiratory Medicine and Pulmonology

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