CASE HISTORY - CASE 4

Presentation

A 57 year old male was admitted late in the day with severe breathlessness. He was given oxygen but collapsed suddenly and died the next morning.

History

On questioning you discover he has been feeling unwell for about 4 weeks, with an increasing cough, exertional dyspnoea and wheezing. This has increased in severity and for the past week he has found it difficult to walk, even to the bathroom. He shows evidence of wasting and knows he has lost weight over the last four weeks. However, prior to that, his wife told him that he was "too skinny" and he thinks his weight fell over the six months previously. He was working in a wrought-iron furniture workshop until three weeks ago when "the dust got too much" and he has been off sick since. He is an ex-smoker with a smoking history of 30 pack-years (number of packets smoked per day X number of years smoked), and drinks approximately two pints of cider once a week

Examination

Test results:

Progression

His breathlessness did not worsen much overnight and he was due to have a bronchoscopy in the morning. However a sudden cardiovascular collapse occurred, associated with massive haemoptysis (coughing up of blood). Unfortunately the loss of blood was large and he died.