Author: Tim Osborne / Editor: Steven S C How / Reviewer: Jolene Rosario, Tim Osborne / Code: RP1, RP2, RP3, SLO1, SLO2 / Published: 26/06/2023
A 77-year-old man attends the emergency department (ED) with a one week history of haemoptysis and shortness of breath. He has central chest pain on coughing. There is no history of fever.
He has a past medical history of ischaemic heart disease, hypertension and hypercholesterolaemia.
His regular medications are aspirin 75mg, atorvastatin 20mg, and ramipril 2.5mg.
He is an ex-smoker who until the last few weeks walked his dog 3 miles a day.
Physical examination of the chest reveals wheeze bilaterally with reduced air entry on the left. There is bilateral pitting oedema to the ankles.
Vital signs are as follows:
- Temperature: 37
- Respiration rate: 24
- Oxygen saturations: 91%
- Heart rate: 90
- Blood pressure: 116/67
His chest x-ray is pictured below:
