Clinical scenario :
A 31-year male an accountant by profession, presented with a persistent cough of six weeks duration. The cough was dry and he denied any history of allergy in the past or any chronic medication. The patient is a non-smoker and also denied any loss of appetite or loss of weight or close contact with any sick patient. There was no history of fever, sweating. He had no change in his voice. There was no history of palpitations, PND or orthopnea. No history of Tuberculosis in the past.
Examination:
He had stable vitals and normal oxygen saturation on room air.
Chest examination: Trachea in the center , The percussion note was normal and on auscultation, there were no added sounds, normal bronchovesicular breath sounds were heard all over.
CVS: S1 and S2 were normally heard There was no murmur, rub or gallop
Abdomen: Normal
CNS: Normal
Evaluation and Hospital course:
The Hemoglobin levels were 14gm/dl and WBC count and platelets were normal. ESR was 4 mm in the first hour. The tests on Kidney and liver function were normal.
Chest X-ray PA view was unremarkable
Keeping in view his nagging cough CT scan chest was done as shown in Fig 1 : A cystic lesion at the azygocaval junction was noted. No other lesions were seen
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| Fig1 Cystic hygroma at right azygocaval junction |
Teaching message :
A normal X-ray chest doesn't rule out all pathological processes in the symptomatic patient.
Further reading click the link: Cystic Hygroma
