Ct Scan Essay

PLAN: I have reviewed the chest x-rays available here and agree with the finding of bleb formation in the right and left upper lobes. Despite the fact that the patient has had a high INR, because of his history of tuberculosis and hemoptysis I believe obtaining sputum for TB is very, very important. We should rule out any other endobronchial lesions as the cause for his bleeding. I have discussed this matter with the patient and his wife. I have told them that there is the possibility of observing the condition by x-rays and repeated tests of his sputum. They understand that this is an option; however, they decided that because of concern regarding his repeated hemoptysis, they would consent to bronchoscopy. We will arrange for the patient to have a bronchoscopy done. He is off Coumadin.

Diagnostic Studies: Flat plate and upright films of the abdomen revealed a localized abnormal gas pattern in the right lower quadrant with no evidence of free air.

Pulse rate is at 72. The blood pressure was 140 / 95,which is suggestive of high blood pressure and related to his medical history. No heart murmur was noted, and no other abnormalities were noted.

A chest X-ray and CT scan result demonstrated a cavitation of the right lower pulmonary lobe. This result alone along with Bob’s history of smoking is a big red flag related to lung cancer. Bob’s history reveals that he has been smoking a ½ pack or more per day for 37 years. According to a study done on the diagnosis, staging, and treatment of lung cancer, habitual smokers have the highest risk of developing cancer of the lung than any other cancer (Herth, Eberhardt, Ernst, 2006). The study also concludes that a related association with lung cancer is swelling of the tissue, lung tumors and/cavitation, lymph in the bronchioles, and paratracheal areas. The swelling can lead to an obstructed airway, which matches Bob’s symptoms as well. Chest pain, stridor, and chest pain are all indications of complications in the respiratory system.

BH was referred to a cardiologist in May, 2015 for complaints of chest pain. He denies chest pain or tightness at present.

Pt received AP diameter X-ray to confirm tube placement and to see if there were any kind of infiltrates because of possible aspiration and to eliminate possible pneumothorax and pleural effusion. Findings included mild patchy infiltrates in the right upper to middle lobes. The left lower lobe also has some similar findings but less concerning. This may either be due to lung infection or pulmonary

History of cardiomyopathy. The most recent echocardiogram was done in 2014 showing improved ejection fraction at 55%. He feels asymptomatic, at this time. He did have recent testing with Dr. Dourdoufis. I will request those notes and review them when they arrive. He will certainly let myself or Dr. Dourdoufis know or seek care if necessary if his symptoms change acutely.

This patient present to the hospital with dyspnea on exertion, dizziness, and pulmonary hypertension. She is a former smoker; she quit the habit in 1980. She underwent a chest CT which showed 4 nodules. There was an 8 mm nodule in the right lower lobe, a 4 mm nodule in the left lower lobe, a 4 mm one in the right middle lobe, and a 4 mm in the left upper lobe. The patient had also already had a right middle lobe wedge resection where a 3.2 centimeter atypical carcinoid was found. A wedge resection is when a triangular shaped slice of tissue is removed. Usually a tumor is taken, and a small amount of normal tissue around it.

shortness of breath. Pain improved with sublingual Nitroglycerine and Aspirin given by EMS. On arrival to ED his blood pressure was 154/94, HR 70 bpm, RR 19 and SpO2 98% in room air. Heart, lung, abdominal and neurological examinations were unremarkable.

“The patient is Adam Rudd, a 78 y/o white male with a history of hypertension. He has been diagnosed with hypertension past 15 years and is on anti-hypertensive medications and aspirin. He is very weak and short of breath. He is accompanied with his longtime friend Jennifer, who reports that Rudd was looking very weak and was complaining of severe headache and blurred vision before coming to the hospital. He is 5’9” and weighs 270 lb. Vital signs recorded were: oral temperature 98.20 F, BP 224/120 mm Hg with a heart rate of 102 beats/minute and respiration of 24 breaths per minute. The pulse oximetry reading was 94% on room air. He is complaining of severe headache and blurred vision. Rudd said that he did not take his antihypertensive medication or aspirin since he ran out of pills. He has not been taking his medication for past 15 days. He reports no known allergies to any medications or other substances.”

On 02/10/2015, he complained of chest pain and shortness of breath. He was evaluated with an electrocardiogram, which was abnormal. His

Imaging: High resolution CT scan of the chest dated July 2015, which was compared, to a previous CT in 2013 shows extensive interstitial disease with honeycomb pattern, right lung greater than left with associated bronchial wall thickening. There seems to have been significant progression since 2013.

Generally, this is a well-developed man sitting comfortably in no acute distress. Skin is warm and dry. HEENT: Head is normocephalic, atraumatic. Pupils equal, reactive to light and accommodation. Sclerae are anicteric. Oral mucosa is moist without lesions. No JVD. No thyromegaly. Lymphatics: No cervical, supraclavicular, axillary, or inguinal adenopathy appreciated. Respiratory: Lungs are clear to auscultation bilaterally. Heart: Regular rate and rhythm. Abdomen: Soft, nontender. Positive bowel sounds. Liver and spleen not palpable. Strength is 5/5 throughout. Neurological exam is

Lungs: Clear to auscultation bilaterally. No wheezes, rales, or rhonchi. Symmetric chest expansion. Breathing nonlabored. Diminished breath sounds in all lung fields. Resonant to percussion.

His gait is normal. No obvious discrepancies in the eye and mouth movement of his face during our discussions here in the office.