Case of the Month February 2017

81-Year-Old Man with Weakness and Edema

Submitted by Garrett Dejesus, MD, and Thomas J. Learch, MD

History of Present Illness

  • 81-year-old man with progressive weakness, abdominal distension, lower extremity swelling for 2-3 months 

Past Medical History

  • Diabetes mellitus Type 2, A1C 7.9%
  • Hypothyroidism
  • Gastroparesis
  • Prepatellar bursitis with drainage (2014)
  • Cervical herniated disc
  • Recently finished a course of ampicillin clavulanate (3 days prior to presentation)

Initial Physical Exam

  • BP 149/60 HR 89 RR 18 T 99 SaO2 94%
  • Gen app: No acute distress and oriented
  • HEENT: Mild dry mucous membranes
  • Resp: Clear bilaterally
  • CV:  Regular rate, no murmurs
  • Abd: Moderate distension, ascites noted, soft
  • Skin: No rashes, no jaundice
  • Ext: Bilateral lower extremity edema
  • Neuro: Within normal limits, no focal abnormalities 

For a larger image, please click Edema 1

         

Above: Frontal chest radiograph demonstrates bibasilar linear opacities suggestive of atelectasis, but with a developing consolidation and/or effusion not excluded. For a larger image, please click Edema 2

           

    Above and below: Chest CT with contrast demonstrates bilateral pleural effusions and a pulmonary nodule in the anterior left upper lobe and abutting the left minor fissure. For larger images, please click on Edema 3 and Edema 4

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    Differential Diagnosis?

    • Infection (bacterial or fungal)
    • Autoimmune (vasculitis or RA, sarcoidosis)
    • Malignancy (lung cancer or paraneoplastic syndrome)
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