55-year-old man with no history of tobacco use who complained of about 6 months

Question

55-year-old man with no history of tobacco use who complained of about 6 months of cough and lower back pain and an 11.3-kg weight loss. He was treated for pneumonia after a chest radiograph showed total opacification of the right lung. Computed tomography imaging subsequently revealed a superior right hilar mass and mediastinal lymphadenopathy. He works as a high school teacher. No family history of heart disease, diabetics, sudden death or cancer. He is a widower with 2 adult children, all all healthy.

Physical exam:

A middle age, not obese, male.

Respiratory rate: 25 breaths per minute (normal 12 – 20 x/minute)

Blood pressure: 150/90 mmHg (normal: 120/80 mmHg)

Heart rate: 105 beats per minute (normal 60-100 x/minute)

Lung: right middle and lower lung dull to percussion, Ronkhi on both lungs on auscultation.  

Temperature: 37ºC. (normal: 36.10-37.20)

What 3 diseases can this guy have?

Explanation / Answer

The differential diagnosis for this guy could be:

- malignancy of lung origin

- tuberculosis.

- lymphoma

- metastatic cancer

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