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CASE PRESENTATION

CASE PRESENTATION. BY DR. ANEFU, N .E @ CTU/PULMONOLOGY UNIT CLINICAL PRESENTATIONS AHMADU 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

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CASE PRESENTATION

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  1. CASE PRESENTATION BY DR. ANEFU, N .E @ CTU/PULMONOLOGY UNIT CLINICAL PRESENTATIONS AHMADU BELLO UNIVERSITY TEACHING HOSPITAL,ZARIA,NIGERIA

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

  3. 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

  4. Weight loss-occasional post-pandrial vomiting good appetite, No diarrhea, No contact Hx • Diagnosed RVD x1yr ago, • No urogenital / other Cardiovascular symptoms

  5. Pregnancy, Delivery, Milestone Hx could not be ascertained, Both parents are mentally impaired- deaf & dumb Father- Lecturer, FCE- OYO Mother-just rounded up NCE

  6. 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

  7. Received Several Anti- malarial & Anti- T.B( empirical) px in 2008 • Repeated in Aprail 2009 • Commenced HAART • (Zudovudine,Lamivudine, Efaviren) 20/10/09

  8. Referred from Barau Dikko Hospital , kaduna On request Seen by paediatricians & Admitted Invited CTU for possible drainage of ?L- sided pleural effusion- 19/7 on admn

  9. Examinations • Small for age Boy, • Ill-looking but cheerful- wasted, silky brownish-hair, digital clubbing, signif. PLN • Not febrile, not pale, no oedema /ascites

  10. 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

  11. 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

  12. CVS= essentially normal • Abdomen=> hepatomegaly 6cm(span=11cm) • non-tender, smooth,firm, no ascites

  13. DIAGNOSIS:- chronic empyema cavity with minimal collection 2o PTB • DDX: (1) chronic lung abscess cavity • (2) pulmonary cyst

  14. PLAN:- CT-scan, • Lung function test (spirometry) • Chest physiotherapy • Cont Anti-T.B • Nutritional rehab

  15. CHEST CT-SCAN

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