CASE PRESENTATION BY DR. ANEFU, 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 Sputum-mucoid, fowl-smelling, copious, dry later Dyspnoea, easy fatigability, nocturnal, Drenching night sweat, Cont. low grade fever, No Haemoptysis, No headache, No convulsion

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

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

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

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

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

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

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

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

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

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

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

CHEST CT-SCAN