Lesley-Anne Eight Months: A Case Study

transitory minor episode of chest pain approximately one year ago while she was vacationing in

Pericarditis: She has pain in the center of the chest, but it is not sharp, short lived, episodic, and radiating to the back in the trapezial area. The pain did decrease when she rolled on to her right side, but it did not decrease when she leaning forward. She doesn’t have dyspnea and tachycardia.

She was found to be on her back in a semi – fowler’s position at 35°. She has full bilateral chest expansion on ventilator assisted breaths. Her ventilator settings were SIMV – PRVC, set rate of 18, tidal volume of 320, PEEP of +6, pressure support of +10, and FiO2 of 60%. Upon auscultation bilateral rhonchi was heard throughout all anterior lobes; bilateral chest tubes are in place. HEENT showed bloody secretions coming from the mouth. Lower extremities showed increased pitting edema with no signs of deep vein thrombosis in the

The skin of the posterior chest is even and consistent to the rest of the body. It is smooth with no scarring. The thorax is symmetrical, there are no signs of any curvatures such as scoliosis. Chest expansion is symmetrical, no pain noted when patient inhaled. Tactile fremitus is normal vibrations are palpable. There are no adventitious lung sounds. There is no tenderness or pain in the costovertebral area, which indicates inflammation of the kidneys. Anterior chest is symmetrical, and color is even and consistent with genetic background. No limitations of ROM in the upper extremities, patient was able to push and pull his arm against my resistance. There was no pain noted when assessing patients ROM, yet a little popping in the right wrist. Patient was able to perform active ROM, he was able to follow and perform my commands with no assistance. Patient had normal lung sounds, no adventitious sounds we heard over the anterior chest. No tenderness or masses felt during palpation. Did not assess breast and axillae. There is no medications or surgeries related to the respiratory system.

One was an abstract that described increased FDG due to impacted foreign body that was subsequently removed through bronchoscopy and was proven to be a fishbone [19]. Patient was 62-years old and presented with recurrent cough. The second case described PET/CT positive right lung nodules in a patient with history of left lung cancer post resection [20]. A biopsy was performed which confirmed the nodule to be a granuloma with foreign body giant cells and debris of calcifications. Patient was 49-years old and asymptomatic at the time of presentation. In our case, patient presented with hemoptysis and was only 25 years at the time of

At today's visit, she is found sitting in her chair. She is awake, alert. She complains of chronic dull, intermittent pain in her right lower extremity with a severity of 4/10. She states that her current pain regimen helps relieve her pain. The staff reports that she her pain regimen seems to manage her pain well. She denies shortness of breath, depression and chest pain.

The patient tells me her symptoms started last Thursday. She started with a cough and she is also noticing some congestion and her ears are feeling blocked. That is a newer symptom for her. She has had a sore throat, but she is not sure if it is truly a sore throat or whether it is just from her coughing. She has not checked her temperature, but has felt chilled and achy at times, but is not sure if she has had a fever. She has also been taking Advil. She does not feel short of breath, but the cough is keeping her up at night. She does not have a history of asthma. She does not use inhalers on a regular basis. About a month and a half ago, she had some

This 51 years old African-American came to the clinic with a five-day history of a cough and shortness of breath. Cough is productive/clear and usually gets worse at night when the patient is lying down. He explained that he has observed some wheezing and that his chest feels tight. He has a low-grade fever of 99.5, but with no chills. He is worried that he may be having pneumonia. He has tried over the counter cough medication without any relief. He denies any edema, but reports SOB with exertion after walking for a short while. She has a history of well-controlled

74 y/o female who presented with worsened shortness of breath and cough. A review of the medical records indicates that she suffers from multiple medical illnesses which include bilateral DVT of lower extremity, chronic COPD and Chronic CHF with low oxygen sat and oxygen dependent. She also suffers from recurrent pneumonia and past medical history of lungs cancer S/P lobectomy. The patient denies pain, reports shortness of breath and poor appetite, she appears cachectic/emaciated with visible muscle wasting.

Just to let you know recent blood tests including an autoimmune screen, FBE, U&Es, LFTs and urinalysis have all come back unremarkable. A chest x-ray demonstrates blunting to the left costophrenic angle indicating a small reaccumulation.

Mrs Levchenko shows signs of excessive work of breathing, sitting in a fowler’s position, use of accessory muscles, coughing and taking breaks between words while talking.

Should she become more symptomatic in the near future, it would be reasonable to perform bronchoscopy for AFB cultures and should those results be positive, I believe further consideration for Mycobacterium avium complex infection therapy would then be warranted. She does have some plural thickening as noted on her CT scan in May and I have ordered a six-month repeat CT scan for follow up. It is interesting to note that she does have some nodular disease that are both tree and bud as well as in a bronchovascular distribution, which calls to question the possibility of sarcoidosis as well. However, she does not have any significant mediastinal or hilar

I have caught up with Ray around three months since the last appointment. Since that time, Ray believes his cough has increased and is essentially back to how it was prior to commencing inhaled steroids. He continues to produce small amounts of thick clear phlegm in the absence of reflux or sinus symptoms. Again, he is reporting some wheeze which only occurs when there is mucus build-up in his airways. Chest auscultation today is clear.

Pulsus paradoxus (exaggeration of the normal variation in the pulse volume with respiration, becoming weaker

Two weeks ago, she had what sounds to be viral upper respiratory tract infection which has caused a profound worsening of her cough. She also believes with the normal laryngeal cough which she is describing has changed in nature and she is describing a bronchitic type cough, though it is not productive. Thank you for organising a chest x-ray which did not reveal any significant abnormalities. I