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