Naveen Verma, MD

September 14, 2005

For the past 6 weeks, a 72-year-old woman with a history of ovarian cancer had had intensifying dyspnea. Initially, she thought her breathing problem was caused by progressive congestive heart failure.

September 14, 2005

Painful eczematous lesions at the angle of her mouth and the base of her nostrils had been bothering a 52-year-old woman for 3 days. Some of the vesicles had ulcerated and left a crust over the region. The patient said she had had similar attacks in the past. The diagnosis of recurrent herpes simplex virus 1 (HSV 1) infection was made. The patient was treated with acyclovir for 1 week, and all the lesions disappeared.

September 14, 2005

With a 1-year history of episodic wheezing, a 62-year-old woman (a smoker for the past 30 years) was being treated for bronchial asthma, but bronchodilator therapy did not control her symptoms. She was hospitalized with worsening dyspnea and a 4.5-kg (10-lb) weight loss over the past 3 months. There was no hemoptysis.

September 14, 2005

A 30-year-old man, who was homeless, was admitted to the hospital with a several-month history of dyspnea and fever. He complained of producing excessive sputum and having frequent bouts of hemoptysis. Bilateral crackles were heard during examination of the lungs. The patient was in acute respiratory distress and was intubated to provide ventilatory support.

September 14, 2005

For the past few days, a 75-year-old man with a history of chronic obstructive pulmonary disease had suffered from dyspnea and fever (temperature, 38.3°C [101°F]). He also complained of producing excessive foul-smelling sputum but denied any hemoptysis.

September 14, 2005

A 25-year-old man, who was an injection drug user, presented with a several-day history of dyspnea and fever. He complained of excessive malaise, fatigue, and weight loss but denied any hemoptysis. The examination of the lung revealed bilateral crackles in both lower zones.

September 14, 2005

A 67-year-old man had been hoarse since undergoing a thyroidectomy for carcinoma nearly 3 months ago. Indirect laryngoscopy now confirmed paralysis of the right vocal cord, which was fixed in the paramedian position. The left vocal cord appeared normal.

September 14, 2005

A 40-year-old woman with a history of amenorrhea complained of recent headaches and galactorrhea for the last 6 months. A neurologic work-up revealed bitemporal hemianopia, and a radiograph of the skull suggested an enlarged sella turcica. A large pituitary adenoma disclosed by an MRI and a serum prolactin level of 360 µg/L led to a diagnosis of prolactinoma.

September 14, 2005

A 56-year-old man who had hematuria for 2 weeks underwent ultrasonography. This disclosed a well-circumscribed cyst in the lower pole of the left kidney and echogenic foci in the upper pole of the right kidney, without any evidence of posterior shadowing. A hyperechoic, well-circumscribed, circular focus was also seen in the right lobe of the liver. Abdominal CT confirmed the presence of a left renal cyst and revealed a 4.7-cm hypodense lesion in the right lobe of the liver, which suggested hemangioma.

September 14, 2005

Having been treated for pulmonary tuberculosis (TB) 25 years earlier, a 60-year-old man (a nonsmoker) now complained of a chronic cough. The cough was occasionally accompanied by yellowish sputum but no hemoptysis. Examination revealed persistent coarse crackles in the right posterior hemithorax, and the x-ray study seen here established the diagnosis of cystic bronchiectasis.