Pt goes to PCPdoc for antibiotics for what appears to be a URI. Doc prescribes antibiotics and, noting that pt is sob and wheezing, also orders a CXR and bronchodilators. Pt sputum sample is negative, but CXR is positive for bronchial pneumonia and nodules. Followup CXR repeats nodule dx.
Pt is then sent for CT scan. Pt shows no real improvement after course of antibiotics, but the bronchodilators do help. CT scan shows cavitating nodules, suggests dx as fungal infection, septic PE, TB, or CA. Pt is neg for TB and septic PE. (No blood work was done prior to CT scan.)
About a month drags by while all this is going on.
One night, Pt has episode of respiratory distress lasting several hours, but pt does not go to ER and therefore cannot prove respiratory distress; c/o awakening "gasping for air for about 4 hours, feeling dry, and after several quarts of fluids, finally began crying in frustration and fear, then finally coughed, relieving the symptoms almost immediately." Pt goes to PCP for f/u one week later. PCP explains episode as "mucous plug." PCP orders pulmo consult.
Pulmo guy admits he doesn't know what x-rays or CT scan means, but neither X-rays look like typical pneumonia to him. Because there is no baseline and because pt "doesn't appear to be acutely ill--no loss of appetite, no real c/o except SOB-- but X-rays are definitely abnormal," Pulmodoc doesn't think it's fungal infection or Ca. Pulmodoc actually suggests that pt could've had nodules for a long time, and pneumonia was coincidental. Pt then pointed out that there had been no real improvement with the pneumonia-like symptoms. Pulmodoc said lungs were clear. Pt pointed out that lungs might be clear because pt was taking bronchodilators??!
Pulmo guy sets up appt for PET scan, explaining that it's less invasive than wedge resect
, and does some blood tests.
Anyone have any ideas what could be going on here????