Contents
1. Clinical Approach to Respiratory System 1
History Taking 1
General Survey 5
Examination of Respiratory System 7
Examination of Other Systems 25
2. Clinical Data Analysis 26
First Step 26
Second Step 27
Third Step 27
Fourth Step 28
Fifth Step 28
Sixth Step 29
Seventh Step 29
Eighth Step 30
Ninth Step 30
Tenth Step 30
Some Fundamental Governing Theories of Clinical Medicine 31
3. Cases 33
Respiratory Diseases Discovered Accidentally by Chest Radiology 33
Case 1: Asymptomatic Man with Hilar Calcification 33
Case 2: Calcification in Solitary Pulmonary Nodule 35
Case 3: Asymptomatic Spn in Smoker 38
Case 4: Accidental Discovery of Irregular Calcification 41
Case 5: An Adolescent Boy with Ill-defined Nodular Opacities 43
Case 6: An Elderly Man Carrying Signs of Long-standing Pain 46
Case 7: Accidental Detection of Bilateral Hilar Lymphadenopathy 48
Case 8: A Young Lady with Chronic Nonspecific Symptoms 51
Case 9: Accidental Discovery of Left-sided Air-fluid Level 55
Patients in Emergency with Respiratory Problem 59
Case 10: A Young Man had a Road Traffic Accident 59
Case 11: A Rare Cause of Shock 62
Case 12: Elderly Man with Acute over Chronic Respiratory Insults 66
Case 13: Pneumothorax with Reticulonodular Opacities 68
Case 14: A Case of Shock with Pleural Effusion 72
Case 15: Massive Hemoptysis with Past History of Pulmonary Tuberculosis 75
Case 16: Tuberculosis with Sudden Onset of Dyspnea 78
Case 17: A Young Girl with Sudden Onset Respiratory Distress 81
Case 18: Man with Fracture Neck Femur 83
xii 101 Cases in Respiratory Medicine
Obstructive Airway Diseases 87
Case 19: Middle-aged Housewife with Non-responding Dyspnea 87
Case 20: Asthmatic Patient came with Hemoptysis 90
Case 21: Unresponsive Chronic Obstructive Pulmonary Disease 95
Case 22: Early Onset COPD or Late Onset Asthma 98
Case 23: Frequent Exacerbations of COPD 102
Case 24: A Simple Case Suddenly got Astonishing Attention 105
Case 25: A Common Presentation of a Rare Disease in Adult 108
Case 26: COPD with Rapid Change in Chest Radiology 112
Respiratory Problems in Intensive Care Unit 117
Case 27: Elderly COPD Patient came with Leukocytosis 117
Case 28: An Unusual Associate Disease in COPD 119
Case 29: A COPD Patient with Type II Respiratory Failure 123
Case 30: Ventilated Patient with Opaque Left Hemithorax 126
Case 31: Masked Metabolic Acidosis in ICU 129
Case 32: An Elderly Man with Metabolic Alkalosis 131
Case 33: Young Asthmatic with Deteriorating ABG 134
Case 34: Elderly Lady with Respiratory Acidosis 137
Case 35: Obese Lady with Metabolic Syndrome 140
Case 36: Guillain-Barré Syndrome with Ventilatory Failure 144
Case 37: An Adolescent Girl with Hypoxic Respiratory Failure 148
Case 38: Hypoxia with Bilateral Lung Infiltrates 151
Case 39: Acute Onset of Dyspnea in SLE 156
Case 40: Bilateral Consolidation in a Young Lady 159
Diffuse Parenchymal Lung Diseases 164
Case 41: DPLD with Systemic Manifestation 164
Case 42: A Classical Textbook Case of DPLD 169
Case 43: DPLD with Changing Diagnosis 174
Case 44: Importance of Untold Story 179
Case 45: DPLD Presented Like Tuberculosis 183
Case 46: Boy with Cervical Lymphadenopathy and Pneumothorax 187
Case 47: Lady with Recurrent Pneumothorax 192
Case 48: Lady with Peripheral Lung Opacities 195
Case 49: Persistent Cough in Smoker 199
Case 50: Persistent Cough in Rheumatoid Arthritis 202
Case 51: Revisiting a Diagnosed Case 205
Case 52: Sarcoidosis with Pleural Effusion 209
Tuberculosis 216
Case 53: A Boy with Progressing Pneumonia 216
Case 54: A Lady with Puerperal Fever 219
Case 55: A Middle-aged Lady with a Round Opacity 222
Case 56: A Young Man with Toxemia 225
Case 57: Life-threatening Episode Associated with Tuberculosis 229
Case 58: A Long Journey Seeking Treatment 236
Case 59: A Young Man with Non-responsive TB 239
Case 60: Man with Multiple Rib Erosions 242
Case 61: Persisting Cavity Despite Treatment 245
Case 62: Recurrent Right Paratracheal Lymphadenopathy 249
Case 63: Old Man with Pleuropulmonary Disease 253
Contents xiii
Pleural Diseases 257
Case 64: A Classical Tuberculous Pleural Effusion 257
Case 65: Hemorrhagic Pleural Effusion with Low Adenosine Deaminase 260
Case 66: Changing Diagnosis 263
Case 67: An Elderly Lady had a Concealed Truth 266
Case 68: Right-Sided Loculated Empyema 269
Case 69: Encysted Pleural Effusion with Liver Cyst 274
Case 70: Thoracic Sequel of Past Sin 278
Case 71: Bilateral Empyema Thoracic 281
Case 72: Asymptomatic Lady wants to go Home 285
Case 73: Boy with Hyperlucent Right Lung 287
Case 74: A Case of Multiple Fluid-filled Cysts 291
Lung Infections 294
Case 75: Typical Lobar Pneumonia 294
Case 76: A Young Lady with Toxemia 299
Case 77: Unresolved Pneumonia 301
Case 78: Lady with Bilious Expectoration 309
Case 79: A Case of Multiple Air-fluid Levels 313
Case 80: Right Lower Lobe Lung Abscess 316
Case 81: A Case of Gas under the Diaphragm 320
Case 82: Old Man with Suspected Lung Cancer 323
Case 83: Lady with Triangular Opacity Behind Heart 326
Thoracic Malignancy 330
Case 84: Elderly Man with Right Lung Collapse 330
Case 85: A Young Man Presented as Left-Sided Pleural Effusion 333
Case 86: A Middle-aged Man Presented with Consolidation 336
Case 87: Elderly Man with Left Upper Lobe Cavity 339
Case 88: Localized Rhonchi in Adult 344
Case 89: Man with Chest Wall Mass 346
Case 90: Man with Amazing Chest Wall Swelling 349
Case 91: Copd with Raised Left Dome of the Diaphragm 353
Case 92: Diffuse Parenchymal Lung Disease with Severe Chest Pain 357
Case 93: Lady Presented with Right-sided Fibrothorax 360
Case 94: Man Diagnosed as Cervical Spondylitis 364
Case 95: A Case of Superior Vena Cava Syndrome 367
Case 96: A Middle-aged Man Presented with Recurrent Hemoptysis 371
Case 97: Adolescent Girl with Unilateral Pleuroparenchymal Disease 376
Case 98: Adolescent Girl with Anterior Mediastinal Mass 380
Case 99: Young Man with Opaque Left Hemithorax 384
Case 100: Atrial Septal Defect with Multiple Nodular Opacities 388
Case 101: A Young Man with Nodules Behaving Differently 391
Index 399
