A 68-year-old male presented with a 1-month history of persistent dry cough, nocturnal coughing exacerbations, hemoptysis, and chest pain exacerbated by coughing, along with weight loss and malaise. He had a history of recurrent gastrointestinal bleeding, exposure to tuberculosis, and long-term exposure to cable processing industry. Examination found decreased breath sounds and dullness on the right lung. Investigations showed anemia, elevated ESR, and a consolidation in the right lower lobe on HRCT with pleural adhesions. A provisional diagnosis of carcinoma, tuberculosis, or interstitial lung disease was made.

1. CASE PRESENTATIONonRespiratory MedicineModerator:Dr. B. LaskarProfessor & HeadThe Department of MedicineAssam Medical College & Hospital DibrugarhPresenter: Tanoy BosePost Graduate TraineeDepartment of MedicineAssam Medical College & Hospital

2. PATIENT PARTICULARSKHAGEN BARUAH68 years; Male; HinduRetired Clerk from Assam State Electricity BoardAddress: Doom Dooma, Dist: Tinsukia, AssamBed: 88; Unit: Male Med Unit VDate of Admission: December 5th, 2008Date of Examination: December 14th, 2008

3. CHIEF COMPLAINSCough for last 1month2. Chest pain for last 1month

4. History of Present Illness: COUGHGradual onset, progressive

5. Harsh, forceful, wheezy and in frequent bouts

6. Persistantthro’out the day, more at night

7. Minimalmucoid expectoration with one episode of blood tingingHistory of Present Illness: COUGHNot assocatied with

8. Profuse expectoration

9. Alteration is quality of cough

10. Fever, night sweats

11. Post nasal drip, hawking, irritation in neck

12. PND

13. Audible wheeze by the family membersHistory of Present Illness: CHEST PAINGradual onset, Slowly progressive, Dull aching

14. Located over anterior chest, w/o radiation or referral

15. Persistentthro’out the day , w/o any variation

16. Aggravated on coughing/deep breath w/o change in character

17. No postural, diurnal, temporal variation

18. Symptomatically improved after admission for last 5 daysHistory of Present Illness: CHEST PAINNot associated with:

19. Sweating, palpitation, radiation to arms or neck

20. Sudden severe attacks requiring emergent care

21. Superficial skin eruptions

22. Trauma

23. Chest heaviness or tightness

24. Regurgitation of food, hawking

25. ExertionaldyspneaHistory of Present Illness: Positive HistoryThe above symptoms were associated with:

26. Weight loss over last 1 month

27. Malaise, muscle pain, headcahe

28. Pain in the back of neck… dull aching , aggravated by extremes of movement for last 14 days

29. Mild hoarseness of voice for last 14days

30. Hospitalisation for these complains 15 days back from where he was refferredHistory of Present Illness: Negative HistoryThere was no history of

31. Fever, recurring drenching night sweats

32. Pain abdomen,LBP,Bleeding from natural orifices

33. LOC, seizure, syncope

34. Flushing, diarrhea, skin eruptions