tag:blogger.com,1999:blog-12660458.post111843171037669994..comments2023-09-01T10:33:09.297-04:00Comments on Pulmonary Roundtable: 26 year old with asthmaUnknownnoreply@blogger.comBlogger7125tag:blogger.com,1999:blog-12660458.post-1118773912495820402005-06-14T14:31:00.000-04:002005-06-14T14:31:00.000-04:00I keep staring at the CxR, but the size doesn't gi...I keep staring at the CxR, but the size doesn't give me very good definition. On the PA the density looks very well circunscribed. On the lateral it almost looks like some interstitial stuff such as bronchiectasis and a pleural-based density. How about a CT?Baleeirohttps://www.blogger.com/profile/03993066135160692535noreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1118773289778372322005-06-14T14:21:00.000-04:002005-06-14T14:21:00.000-04:00It's not your monitor. Look closely at the CXR, a...It's not your monitor. Look closely at the CXR, and focus on the LLL/retrocardiac space.Jeff Hhttps://www.blogger.com/profile/01209432708535732499noreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1118768317069573292005-06-14T12:58:00.000-04:002005-06-14T12:58:00.000-04:00BTW, Jeff, is it the resolution on my minitor or h...BTW, Jeff, is it the resolution on my minitor or his lung bases seem a bit more crowded on that lateral view?Baleeirohttps://www.blogger.com/profile/03993066135160692535noreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1118765361541671022005-06-14T12:09:00.000-04:002005-06-14T12:09:00.000-04:00It seems to be a case of persistent bronchospasm s...It seems to be a case of persistent bronchospasm similar to Mike L's (http://pulmonaryroundtable.blogspot.com/2005/06/reactive-airway-disease.html). The questions are similar to the ones posed for that case,i.e. is this indeed asthama? If it is, GERD, post-nasal drip and laryngeal dyskinesia could be reasons for the persistence of symptoms.<BR/>He has marked obstruction, concerning for airway remodelling already. Conditions mimicking asthma (ABPM, Churg-Strauss), should be considered. Have you done an ANCA, Aspergillus, etc.?<BR/>Since he has recent travel Hx, I will add parasitic diseases. Loefler's (transit of helminth larvae through the lungs) will cause bronchospasm, peripheral eosinophilia and they usually have fleeting non-dense infiltrates. He does have 10% Eos, so it would be inexpensive and reasonable to check stool for O&P.Baleeirohttps://www.blogger.com/profile/03993066135160692535noreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1118508108534352042005-06-11T12:41:00.000-04:002005-06-11T12:41:00.000-04:00TB is, as you point out, always a a good thought....TB is, as you point out, always a a good thought. As he had come to the US as a student, he had had a PPD which was negative. I repeated the PPD. Further, since his pneumonia that was treated a year earlier, he had not had any fever/chills/sweats or weight loss. The CXR is not typical for TB. Other findings (which have been presented) guided his evaluation...Jeff Hhttps://www.blogger.com/profile/01209432708535732499noreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1118489659487008282005-06-11T07:34:00.000-04:002005-06-11T07:34:00.000-04:00My first thought was also TB but now I'm not so su...My first thought was also TB but now I'm not so sure as there seem to be no other complaints...Aspergillis is normal but one <I>could</I> consider a bronchitis. I'd like to look for other bugs as well as TB. But then, I'm a student.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1118463436476565912005-06-11T00:17:00.000-04:002005-06-11T00:17:00.000-04:00Doctors who have worked in Asia learn an important...Doctors who have worked in Asia learn an important differential for a symptom profile like this one.<BR/><BR/>The first item on the differential is always TB. <BR/><BR/>The second item is TB. <BR/><BR/>The third, in case you didn't catch it, is also TB.<BR/><BR/>After that, you can start considering "everything else."<BR/><BR/>But never forget the first three.Anonymousnoreply@blogger.com