CASE PRESENTATION

BY DR. ANEFU, N .E@ CTU/PULMONOLOGY UNIT

CLINICAL PRESENTATIONSAHMADU BELLO UNIVERSITY TEACHING

HOSPITAL,ZARIA,NIGERIA

• S. H• 15 yrs, M• SS2• YORUBA• ISLAM• DALA RD U/RIMI GRA KADUNA• DOA= 30/09/10

Complaints

• Recurrent cough& fever X2yrs• Index symptoms x 2/12

• Sputum-mucoid, fowl-smelling, copious, dry later

• Dyspnoea, easy fatigability, nocturnal, Drenching night sweat, Cont. low grade fever,

• No Haemoptysis, No headache, No convulsion

• Weight loss-occasional post-pandrial vomiting good appetite, No diarrhea, No contact Hx

• Diagnosed RVD x1yr ago,

• No urogenital / other Cardiovascular symptoms

Pregnancy, Delivery, Milestone Hx could not be ascertained,Both parents are mentally impaired- deaf &

dumbFather- Lecturer, FCE- OYOMother-just rounded up NCE

• No Hx of blood transfusion or surgery in the past

• No Hx of use of unsterlized sharp objects

• Not a known SCDx, Asthmatic, HTN or D.M pt• No family Hx

• Received Several Anti- malarial & Anti- T.B( empirical) px in 2008

–Repeated in Aprail 2009 –Commenced HAART – (Zudovudine,Lamivudine, Efaviren) 20/10/09

Referred from Barau Dikko Hospital , kaduna

On request

Seen by paediatricians & AdmittedInvited CTU for possible drainage of ?L- sided pleural

effusion- 19/7 on admn

Examinations

• Small for age Boy,

• Ill-looking but cheerful- wasted, silky brownish-hair, digital clubbing, signif. PLN

• Not febrile, not pale, no oedema /ascites

• Chest: RR= 34cpm• Asymmetry –depressed L-ant. Lower zone• Trachea- deviated L• Chest expansion, T/V fremitus on L ant/ latly

but postly• PN: dull L, resonant R• Widespread bronchial breath sounds, L side• Crepitations onR upper zone

Available Chest X-rays

• 05/10/10=> partially collapsed L-Lung, hazy opacity latly, scattered patchy opacities both lung fields, more on the lower zones

• 19/10/10=> collapsed L-Lung, circum area of radio-luscency,thickened pleura on L- side, minimal air-fluid level, patchy opacity on R as above

• CVS= essentially normal

• Abdomen=> hepatomegaly 6cm(span=11cm)• non-tender, smooth,firm, no ascites

• DIAGNOSIS:- chronic empyema cavity with minimal collection 2o PTB

–DDX: (1) chronic lung abscess cavity

– (2) pulmonary cyst

• PLAN:- CT-scan, – Lung function test (spirometry)

–Chest physiotherapy–Cont Anti-T.B–Nutritional rehab

CHEST CT-SCAN