Solving the enigma of the pneumological case

Aida-Andreea Fănică

„Marius Nasta” Pneumology Institute Bucharest

Ileana Rohan

„Marius Nasta” Pneumology Institute Bucharest

Florin Dumitru Mihălțan

„Marius Nasta” Pneumology Institute Bucharest „Carol Davila” University of Medicine and Pharmacy Bucharest

Keywords: cavity, sputum, tuberculosis, cancer

Introduction

There are two pneumological pathologies with similar symptoms: tuberculosis and bronchopulmonary cancer. The common symptoms of the two major health problems, both in Romania and the world are: dyspnoea, cough with expectoration, haemoptysis, inappetence, and subsequently, weight loss. The difference is in the treatment, which may be a curative or palliative one.

Objectives

The purpose of this paperwork is to highlight the similarities between the two conditions but also to differentiate them with the help of paraclinical investigations, for the purpose of finding the suitable treatment.

Material and methods

I submit the case of a 64-years old male patient, active smoker, who presents in our facility accusing dyspnoea following moderate efforts, cough with mucous expectoration, weight loss, and physical asthenia manifested for 1-2 months. The intriguing part of the case is represented by the radiological aspect, where some 4/4 cm, faded-contour, inhomogeneous opacities of subcostal intensity are found in the right superior lobe, and the left superior lobe, bilateral accentuated interstitial drawing, and free costaldiaphragmatic sinuses. Therefore, we are in the search of either an infectious or tumoral diagnosis. We continue paraclinical investigations for this patient testing the sputum for tuberculosis, performing bronchoscopy, CT scan, as well as interdisciplinary examinations.

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Results

In the beginning, the results of the tests are not revealing for the case. Multiple negative bacteriological examinations for tuberculosis sampled from the sputum, bronchial suction, a cytological test of bronchial suction with the conclusion: tumoral suspect, suspicion of adenocarcinoma and the histopathological tests do not comply with a tumoral sublayer.

Conclusions

Thoracic surgery and pathological anatomy are the ones to determine the certain diagnosis of the patient.

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