|Year : 2013 | Volume
| Issue : 2 | Page : 164-165
Sudden onset of dyspnea in a woman with skin lesions and lung cysts
Akashdeep Singh1, Jaspreet Singh2
1 Department Pulmonary and Critical Care Medicine, Dayanand Medical College and Hospital, Ludhiana, India
2 Department of Anesthesiology, Peninsula Regional Medical Center, Salisbury MD, USA
|Date of Web Publication||11-Apr-2013|
Department Pulmonary and Critical Care Medicine, Dayanand Medical College and Hospital, Ludhiana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh A, Singh J. Sudden onset of dyspnea in a woman with skin lesions and lung cysts. Lung India 2013;30:164-5
A 40-year-old female presented with complaints of sudden onset left sided chest pain, dry cough, and shortness of breath of one day duration.
On admission she was anxious, cyanosed, dyspnoeic and had obvious respiratory distress. She had an oxygen saturation of 78% while breathing room air, respiratory rate of 30/minutes, blood pressure of 140/90 mmHg, and a pulse of 126/minute. Respiratory examination revealed decreased movements, hyperresonance on percussion and distant lung sounds involving the entire left hemithorax. There were multiple, thick, fibrous, reddish-brown papules around the nose, cheeks, and chin conglomerulating to form a characteristic butterfly-shaped pattern [Figure 1]a. Besides this, there were fibromatous plaques over forehead and scalp [Figure 1]a. Her back revealed multiple ash leaf shaped hypopigmented macules and toenails revealed periungual fibromas [Figure 1]b. Her past history revealed that she had mild learning difficulty and had studied till fifth standard and was un-married.
Laboratory investigations including hemogram and routine biochemistry were normal. Chest radiograph showed hypertranslucent left hemithorax [Figure 2]a. Computed tomography of chest revealed left sided pneumothorax and moderate sized right pleural effusion [Figure 2]b. The lung parenchyma revealed bilateral, multiple, variable sized cysts [Figure 2]b with normal intervening lung and preserved volumes. Diagnostic pleurocentesis revealed milky fluid, which was exudative lymphocytic predominant with pleural fluid proteins of 4g/dl, sugar of 100mg/dl, LDH of 344 U/L, pH of 7.60, triglycerides of 130 mg/dl, and cholesterol of 30 mg/dl. Abdominal ultrasound revealed bilateral multiple angiomyolipomas in the kidney and liver.
| Question|| |
Q 1: What is your diagnosis?
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[Figure 1], [Figure 2]