Case 21--Persistent Cough in a Smoker

Clinical summary: A 70-year-old man presented in 4/98 with worsening dyspnea. He also complained of cough with yellow sputum, sometimes blood-streaked, for 7 to 8 months. He had undergone a coronary artery bypass operation and mitral valve replacement with a mechanical valve in 1989. A left nephrectomy was performed in 1992 for renal cell carcinoma. He had a history of hypertension and diabetes. A 100 pack-year smoker, he quit 15 years ago. There was a history of possible asbestos exposure in a shipyard for 2 years. There had been no weight loss or fever. He was on anticoagulants for the mechanical valve. Physical examination showed normal vital signs and lungs that were clear to auscultation. Work-up redemonstrated coronary artery disease as well as cerebrovascular disease, both of which were treated in May and June. During that time, an abnormal chest radiograph was noted. Pulmonary function tests in April showed FVC 3.28 L (68% pred.), FEV1 2.1 L (63% pred.), and FEV1/FVC 64%.

Radiology | Bronchoscopy | Image 1 | Discussion

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