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HPI

HPI. 84 male w/ painless hematuria x 1 week Passing clots like jelly Has had these episodes repeatedly over the years Takes cipro/bactrim and goes away Patient was here 4 months prior for similar problem. Renal U/S showed mass or clot in bladder. ROS. No fevers or chills

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HPI

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  1. HPI • 84 male w/ painless hematuria x 1 week • Passing clots like jelly • Has had these episodes repeatedly over the years • Takes cipro/bactrim and goes away • Patient was here 4 months prior for similar problem. Renal U/S showed mass or clot in bladder.

  2. ROS • No fevers or chills • Some weight loss over the years. Fluctuates up and down. Widowed. • Good appetite • No night sweats • No hemoptysis • No CP, no weakness

  3. PMHx • Hypertension (Diltiazem) • Gouty arthritis (Colchicine) • Anemia • Prostate CA • s/p TURP and EBRT (1991) • PSA <0.1 • Family hx non-contributory

  4. Social history • 50 years x 2 ppd = 100 pack years • No illicits, no alcohol • Lives in Detroit • Retired construction worker • No pets or birds

  5. Physical Exam • AAO x 3. NAD • Lungs CTA no w/r/r • No clubbing, edema, or cyanosis • Neurologically intact • S1/S2 no m/r/g • Abd benign

  6. 134 101 17 95 4.6 24 1.1 Labs • U/A RBC >100, no casts, no whites, nitrite and leukocyte esterase negative 10.7 5.6 313 33.5

  7. Reason for consult • Multiple mets to the lungs

  8. 10/2009 Bilateral pulmonary infiltrates with mass-like lesion in RLL

  9. 10/13/2008

  10. 8/2008

  11. What comes next? • A. Bronchoscopy with biopsy • B. Sputum for malignant cells • C. CT chest • D. Other

  12. More History… • Underground construction worker • Has been exposed to lots of dust and particulate matter • Involved in shaping/cutting/forming concrete • Says some of his co-workers have died of “lung disease” and specifically silicosis • He has know about his lungs for more than 10 years, doesn’t want any work up

  13. 10/13/2008

  14. 10/13/2008

  15. 10/13/2008

  16. CT scan from 2000 • Patient has been told about these lung nodules more than 10 years ago • “Innumerable nodules visualized in both lungs” • We recommended annual PPD and follow up yearly as he may worsen and need oxygen.

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