Dyspnoea case based
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This document presents 6 case studies of patients presenting with dyspnoea or shortness of breath. Case 1 describes a 72-year-old woman admitted to the hospital with fever and progressive shortness of breath with a history of rheumatoid arthritis. Case 2 involves a 45-year-old heavy smoker with increasing dyspnea, cough, and finger clubbing. Case 3 is about a 76-year-old man with exertional dyspnea and multiple conditions including myasthenia gravis. Case 4 presents a 48-year-old male with fever, cough, weight loss, and right-sided chest pain and shortness of breath. Case 5 describes a 66-year-old woman with increasing shortness
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Dyspnoea case based
- 1. Professor Md.Toufiqur Rahman MBBS, FCPS, MD, FACC, FESC, FRCP, FSCAI, FCCP,FAPSC, FAPSIC, FAHA,FACP,FASE Professor and Head of Cardiology Colonel Malek Medical College , Manikganj . drtoufiq19711@yahoo.com DYSPNOEADYSPNOEA (Case based)(Case based)
- 2. Case 1 • A 72 year old woman was admitted to hospital because of a few days history of progressive shortness of breath. She had associated fever but no cough or sputum production. Her medical history included rheumatoid arthritis, for which she had been taking methotrexate for the past 12 years.
- 3. Case 2 • A 45-year-old heavy smoker presented with increasing dyspnea and persistent cough. He had been working as craftsman for 35 years with a history of exposure to cement dust, but not to birds or other animals, fungi or other organic fine particles. He did not report weight loss, sweat or fever. On examination he had normal vital signs and was comfortable at rest. Extremities showed considerable clubbing of fingers and toes. Chest examination revealed fine inspiratory basal crackles. Chest radiograph showed reticulonodular infiltrates in both lung bases. HRCT showed diffuse ground glass opacities predominantly involving the lung bases, and subpleural fibrosis . Pulmonary function test (PFT) showed: a moderate restriction and a moderate to severe diffusion abnormality.
- 4. Case 3 • A 76-year-old man presented with severe exertional dyspnoea. He suffered from mild chronic obstructive pulmonary disease, congestive cardiac failure and seropositive myasthaenia gravis. Clinical examination of his chest and heart were unremarkable but he had speech dyspnoea and was unable to count to 20 in a single breath. Consecutive sniff nasal inspiratory measurements (SNIP) fell from 55 to 33 cm H 2O and forced vital capacity (FVC) fell from 3.4 to 2.4 L. A diagnosis of myasthenic crisis was carried out and treatment with non-invasive ventilation, intravenous immunoglobulis and high-dose oral prednisolone was initiated. The patient responded well .
- 5. Case 4 • A 48-year-old, male patient presented during the day for an urgent consultation. For over 10 weeks, he had had a history of high-grade fever (39°C), cough with mucopurulent expectoration, shortness of breath, right-sided chest pain, weight loss (>10%) and night sweats. General examination showed a thin body build, pale skin and extreme dyspnoea with oxygen saturation of 77%. An examination of the chest revealed air and fluid in the pleural space on the right side of the body. All other systems were checked and were all clinically normal. A posteroanterior chest radiography was performed and showed an air–fluid level in the right hemithorax and a minimal shift of mediastinum towards the left .
- 6. Case 5 • A 66 year old female presented to an outside hospital with increasing shortness of breath and cough. She complained of a non-productive cough for approximately six weeks. She denied hemoptysis but complained of a low grade fever. Over this time she became progressively more short of breath. At the time of presentation she was able to only walk one hundred meters before she had to stop due to dyspnea.Her past medical history included obesity, gastroesophageal reflux disease (GERD), peripheral vascular disease, hypertension, and type II diabetes. Lateral view on chest x-ray demonstrating left upper lobe consolidation. Computed tomography image of the chest demonstrating left upper lobe (LUL) consolidation with endobronchial lesion in LUL bronchus.
- 7. Case 6 • Mr. X 68 yrs old pleasant gentleman admitted in CCU of UHL for respiratory distress along with sweating for 2 hours. He had also history of exertional dyspnoea and dyspepsia for last 4 days. He is diabetic, hypertensive and nonalcoholic. On G/E his Pulse-104/min, BP-120/ 90mmHg, RR-20/min and cardiac examination showed thatthere was a pansystolic murmur over the tricuspid area which increased with accentuated pulmonary component of the second heart sound. Electrocardiography showed sinus tachycardia with SIQ3T3. Chest X-Ray revealed cardiomegaly. 2-D transthoracic echocardiography showed a dilated right side of the heart with a 5.7 cm × 1.4 cm mass in the right pulmonary artery. CT pulmonary angiography found pulmonary embolism involving the right pulmonary artery and most of their segmental branches. He underwent a duplex scan of the deep venous system of both lower limbs, which was found to be deep venous thrombosis in left popliteal vein.
- 67. Thank you all