Case report I
Chest pain
Monika Bratova

A young man, 35-year old, a long-time smoker, with no heath problems in the past, working as a
storeman, grown up in a children´s home
Asthenic habitus, without neurological problems, a regular heart beat, without a heart murmur,
alveolar breathing on the right side, , silent breathing above the left lung, abdomen without any
resistance, down extremities without edema
Symptoms:
Admission due to  acute left-sided chest pain. It started during a corporeal strain. He had no
fever and cough.

Saturation O2 98%
Physiologic ECG
Which basic examination should be done?
Blood account
Biochemistry
Leucocytes 10,2
Urea 2,0
Erytrocytes 4,5
Kreatinine 78
Hemoglobin 140
Kalium 3,6
Trombocytes 250
CRP 30,5

A left-sided borderline pneumothorax in apex up to 2 cm, a cavity in the left upper lobe, pleural
changes in the right upper lobe
A secondary pneumothorax

What is a possible cause of the X-ray finding?
A lung cancer:
PLUS – the X-ray finding, a history of smoking
CONTRA – young age,      a bilateral finding
Vasculitis with lung demonstration:
PLUS – the X-ray finding,
CONTRA – the localization in the upper lobes, an absence of other symptoms (e.g. otolaryngological)
Tuberculosis:
PLUS – localization  in the upper lobes, night sweatting,  a social situation
CONTRA – no contact with TB in a patient´s history
Aspergilosis:
PLUS – the X-ray finding of a cavity
PROTI – no immunosupresive status

Which further examination should be done?
CT scan: Cavities in both upper lobes, calcifications, pachypleural changes, no lympadenopathy, a
left-sided pneumothorax.
A pozitive microscopy of sputum for M.tuberculosis
Autoantibodies (ANA, ANCA, ENA) negative, glucane negative

Conclusion
•Diagnosis of tuberculosis
•The antituberculose drug treament was started (RMP, PZA, INH, EMB), a hospital care for 6 months
is needed •Contacts of patient were found and examined to exclude TB •Conservative treatment of the
pneumothorax was indicated