I just saw this 70 y/o woman in consult today. Her only complaint is dyspnea on exertion: she gets tired after walking more than a mile. No TOB, no Hx of lung Dz.
She had 3-4 episodes of pneumonia within 2 years > 5years ago.
No childhood illnesses.
No chronic cough. Physical exam is unremarkable. PFTs showed a moderate mixed defect.
She has the bronchiectatic/focal cystic changes above and the rest of the CT was normal.
How would you work up her focal bronchiectasis and do think those small areas are sufficient explanation to her dyspnea.
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dyspnea is always difficult to work up because of the subjective nature, I'm sure you have already looked for evidecne of desaturation/hypoxia and checked DLCO. but with regards to her multipe pneumonias and bronchiectasis one of the things I would do would be to work her up for Common Varaible Immune Deficiency.
Interesting case. I guess in this older woman with predominantly dyspnea as her complaint, I would be concerned that something else is going on apart from the small area of bronchiectasis. Does she have small airways disease like bronchiolitis? What is her DLCO? Does she have a neuromuscular, cardiac, or hematologic reason for dyspnea? Has she had a bronch to r/o mass or obstruction?
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