The next patient is an 82 year old male, who was admitted to hospital one month ago with gradual deterioration, confusion, agitation, and poor appetite.

Previous history
  • Pernicous anaemia since 1982.
  • COAD.
  • DVT with pulmonary embolus

    No medication.

    On admission
    Dehydrated, with bilateral lung crackles and wheeze. The chest x-ray showed shadowing at the left lung base (consolidation). A sputum specimen was sent for analysis and came back showing a culture of Haemophilus sp.

    His condition deteriorated, and two weeks ago another chest x-ray showed nodular interstitial shadowing at the left lung base with a bulky right hilum. A CT scan showed similar changes, and the eventual clinical diagnosis was lymphangitis carcinomatosa, although extensive chronic infective causes could not be excluded.

    He died in hospital.