Nagging cough in a young male

Clinical scenario :

              A 31 year  male an accountant by profession , presented with  persistent cough  of six weeks duration . The cough was dry and he denied any history of allergy in the past , or any chronic  medication. Patient is a non smoker and also denied any loss of appetite or loss of weight or close contact with any sick patient .There was no history of fever , sweating  . He had no change in his voice .There was no history of palpitations , PND or orthopnea .No history of Tuberculosis in the past.  

Examination: 

            He had stable vitals and normal oxygen saturation on room air  .

Chest examination : Trachea in center , The percussion note was normal and on auscultation there were  no added sounds, normal bronchovesicular breath sounds were heard  all over.

CVS : S1 and S2 were normally heard There was no murmur , rub or gallop 

Abdomen : Normal 

CNS : Normal 

Evaluation and Hospital course: 

           The  Hemoglobin levels were 14gm/dl and WBC count and platelets were normal . ESR was 4 mm  in first hour  .The tests on Kidney and liver function were normal .    

Chest X-ray PA view was  unremarkable 

Keeping in view his nagging cough  CT scan chest was done as shown in Fig 1 :A cystic lesion  at the azygocaval junction was noted . No other lesions was seen 

Fig1 Cystic hygroma at right azygocaval junction 

         Patient was subjected to Video assisted thoracoscopic surgery  (VATS) and the lesion was resected .It turned out to be Cystic hygroma .Patient had a marked relief and is following our clinic

Teaching message : 

        

        A normal X ray chest doesn't rule out all pathological processes  in a symptomatic patient. 

Further reading click the link:  Cystic Hygroma

This case was contributed by :

Dr. Majed Al-Mourgi .FRCS,FCCP,FACS

Consultant Thoracic surgeon &

Head of Surgery dept 

College of Medicine Taif University KSA