3. Personal History
Male patient
16 years old
Born and living in ELfayoum.
student.
No special habits of medical importance.
4. Present history
The condition started 1 year ago by gradual
progressive dyspnea on moderate exertion with no
orthopnea or PND or chest wheezes .
The condition was associated with dry cough .
He sought medical advice several times and received
non specific medications with no improvement.
5. 3 months ago the patient experienced acute left
inframamary stitching chest pain increased with
respiration, referred to the back and associated with
acute dyspnea
The patient saught medical advice at El fayoum chest
hospital where CXR and CT chest were done and
revealed left side pneumothorax.
6. ICT was inserted and the patient was referred to
cardiothoracic surgery where bullectomy operation
was done with no available data.
1 week before admission , the patient experienced right
inframamary stitching chest pain referred to the back
and increase with respiration , the patient sought
medical advice at Elfayoum chest hospital where CXR
and CT chest were done and revealed right side
pneumothorax.
ICT was inserted and the patient was referred to our
department .
7. No history of hemoptysis or wheezes
No history of jaundice ,right hypochondrial pain or
lower limb oedema
No history of dysphagia or hoarseness of voice
No history of skin or joint manifestations.
No history of fever, anorexia or loss of weight .
The patient is not diabetic or hypertensive
8. Past history
• No history of TB or contact with TB case
• No history of previous operation , blood transfusion or
drug allergy.
11. General examination
Patient is fully conscious ,alert, cooperative
oriented to time, place ,and person , of average
mood and intelligence
lying flat in the bed
18. Inspection
Shape: symmetrical with ICT inserted
on the right side
Respiratory movement: thoraco
abdominal.
Expansion: restricted on the right side
33. HRCT CHEST
Multiple variable sized thin walled dilated cystic air
spaces are noted within both lung fields as well as
scattered patches of air trapping .
Mild right apical pneumothorax is seen with chest tube
seen within it.
Lung parenchyma show mosaic pattern .
No pleural effusion.
Suspected hilar lymphadenopathy for post contrast
study.
34. *Pleurodesis was done & the patient was
discharged
*3weeks later the patient presented to us
with right side stitching chest pain
associated with dyspnea on mild
exertion
52. RHEUMATOLOGY CONSULTATION
The patient has thin inelastic skin and tall finger high
arched foot with hypermobility suspected of Ehlerdanlos
syndrome
Recomendation
Fundus examination for ectopia lentis (normal)
Xray hand ( normal)
53. As regard his sister :
* 14 years old
* 2weeks before admission , the patient experienced left
side pneumothorax, ICT was inserted for 1 week then
removed
* 1 week later , she was admitted with bilateral
pneumothorax & bilateral ICT was inserted
* Pleurodesis was done on the right side then she was
referred to cardiothoracic surgery due to persistent air
leak
58. Pathology report
Gross
2 irregular rubbery greyish brown flattened tissue pieces
,measuring 2.5x1.5x0.5 cm and 2.5x1x0.5cm both bisected
and totally submitted.
Microscopic
Section examined from the specimen received reveal lung
tissue with evidence of emphysema with marked ,
congestion interstitial lymphocytic infiltrate and mild
anthracosis .
No evidence of specific granuloma.
No evidence of malignancy .
60. Pathology report(revision)
Microscopic
Examination of the received slides reveal lung tissue
showing moderately edematous alveolar walls with
areas of mild to moderate interstitial fibrosis and
diffuse interstitial infiltration by lymphoplasmocytic
cellular infiltrate .some lymphoid aggregates and few
neutrophils.many calcified bodies are detected in the
interstitium .few alveoli show bubbly exudate
entangling inflamatory cells. Areas of anthracosis are
also seen.