Case Discussion
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General clinical
Case Discussion
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Hi All Greetings to all I"m General Practitioner from India, Newbie here. This is my first thread here hope you will reply & discuss, Thanks Vijender 24 years male, non smoker c/o Fever , cough, m
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Forums » Open clinical » General clinical » Case Discussion
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Case Discussion
posted at 20/8/2012 9:13 AM BST
on bmj.com
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Posts: 6
First: 7/6/2010 Last: 23/8/2012 |
Hi All Greetings to all I"m General Practitioner from India, Newbie here. This is my first thread here hope you will reply & discuss, Thanks Vijender 24 years male, non smoker c/o Fever , cough, malaise, chest pain right side and loss of appetite for last 1 month,H/O Nausea +, there is not significant weight loss, No family history or patient's past history of any chronic disease including Tuberculosis, Patient was taking medication from some local chemist but was not relieved On Examination; Patient is concious cooperative well oriented to time, place and person vitals stable average built afebrile PR 86 /min good volume regular BP 118 76 mmHG Chest : there is around 10x10 cm erithematous patch (since birth) right side chest tenderness over angle of lewis chest sounds normal no adventitious sound found chest movements b/l normal CVS: s1s2 heard normal no additional sound P/A NAD investigations HB 13gm% TLC 15900 mm3 (4000-11000) DLC N =86% (25-70) L= 14% (20-40) E= 0% (1-6) M= 0% (2-8) B= 0% (0-1) ESR 18mm/ 1st hour Sputum 1 & 2 negative for AFB Mountaux test negative Chest X Ray (attached) showing mass Right side chest near lateral border of heart Treatment Adviced: -CT Chest (contrast enhanced) -T. Amoxiclav 625 tds -T. Combiflam tdd (Paracetamol+ Ibuprofen) -C. Becosule bd (Vit. B complex) |
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Re: Case Discussion
posted at 20/8/2012 8:00 PM BST
on bmj.com
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Posts: 339
First: 17/12/2011 Last: 15/5/2013 |
Interesting. I presume previously fit, now compains of cough, fever, right side chest pains loss of appetite and loss of appetite. Afebrile on examination, neutrophils a bit up so presumably bacterial infection .Certainly an odd looking CXR. Right sided mass near lateral border of the heart. If mass in in lungs rather than in the heart then some for of ?pleural abcess. I cant recall having seen such a CXR in the UK , but I work in general Practice and not in chest medicine. |
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Re: Case Discussion
posted at 21/8/2012 8:26 AM BST
on bmj.com
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Posts: 6
First: 7/6/2010 Last: 23/8/2012 |
In Response to Re: Case Discussion: I have asked patient for CT Scan (Contast enhanced), Soon I'll Upload, I think It might be ?LYMPHOMA |
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Re: Case Discussion
posted at 25/8/2012 8:20 AM BST
on bmj.com
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Posts: 5
First: 15/8/2012 Last: 18/5/2013 |
In Response to Re: Case Discussion: CT vill be helpful for diagnosis. İn addition to other possible diagnosis, it can be esophagus diverticulitis. Posted by makdeniz Has anyone thought to dip-test his urine for proteinuria?? Lymphoma likely to produce Bence-Jones protein; if present protein electrophoresis to confirm: cheaper than CT/MRI scanning: Further clue may be his response to alcohol: often produces a much more severe reaction e.g. gastritis, nausea, headache, "hangover" from much smaller intake. can cause confusion with oesophageal pathology as non-responsive to PPIs/H2s. Any lymphadenopathy elsewhere?? axillary/sub clavicular possible sites perhaps causing muscle pains/pain joints. |
Forums » Open clinical » General clinical » Case Discussion
