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What Could Cause Persistent Cough For Close To Three Weeks?

Posted on Tue, 8 Mar 2022

Question: Hello Sir,
My mother is 60 years old and having cough from last 15-20 days, We did chest PA, Blood and Urine test and found the below Major results:

Blood:
WBC count - 13200/cu mm

Urine:
Pus Cells - 15-20/hpf;
epithelial cells - 6-7/hpf
Proteins - Present(Trace)
Bacteria - Present

Radiogram - Chest PA
Triangular specification seen in the right upper paraspinal region? Azygous lobe.
Visualised projection of the rest of the lung fields are clear.
both pleural spaces are clear.
Hilar shadows appear normal.
Trachea and carina appear normal
Borderline cardiomegaly with mildly unfolded aorta. rest of the cardiac silhouette is within normal limits.
Both the diaphragms appear normal
Impression: ? Azygous lobe ; cardiomegaly with unfolded aorta.

Is this something serious? Please advice further action needs to take?

At the moment below medicines are advised:
T. Clarigard 500
Syp. Etag 10ml
T. Cetil 250
T. Leozen 500
Syp K-cyt
T Niftas 100mg

Answered by Dr. Drkaushal85 (27 minutes later)

Brief Answer:
Do you have any previous chest x ray of her?

Detailed Answer:

Hi,

Azygous lobe is normal variation in lung anatomy.
It can be seen in 1-2% individuals.
So having Azygous lobe is normal thing.
But we need to confirm this.
And this is possible if you have any previous chest x ray of her.
If previous X-rays also show similar opacity then it is Azygous lobe only.
If previous chest x ray is not showing any opacity then possibility of pneumonia is more.
So please let me know if you have any previous chest x ray of her.

I also want to know about other symptoms of pneumonia.
Does she have expectoration?
Does she have fever?
Does she have chest pain?
Please reply me answers of above asked questions.
She is also having cardiomegaly on chest x ray.
So we also need to rule out heart failure as a cause for her coughing.
So please let me know if her blood pressure is under control or not.

I will be happy to help you further. Wishing good health to your mother. Thanks.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Drkaushal85 (2 hours later)

Thanks Sir for your prompt reply. Below are the answers to your questions..

If you have any previous chest x ray of her. - Yes there may be but I need to check. Will get back to you by tomorrow on this.

Does she have expectoration? No
Does she have fever? No
Does she have chest pain? Very light but not continuous, only when she get cough.
Blood pressure is under control and normal.

Please suggest the further treatment.

Thank you.

Answered by Dr. Drkaushal85 (7 minutes later)

Brief Answer:
Continue same treatment.

Detailed Answer:

Hi,

She is taking treatment of pneumonia.
So better to stick with the treatment.
Do let me know once you find previous x ray.
I am also thinking about cardiomegaly on chest x ray.
All hypertension patients with cardiomegaly should be evaluated for heart failure.

So please let me know
1. Does she have breathlessness?
2. Has she ever undergone 2d echo?

Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wishing good health to your mother. Thanks.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Drkaushal85 (3 hours later)

The answers of your questions is 1-No 2-we did the 2d echo long back for some reason when she was first diagnosed with BP. Not sure if I can find those old x-ray, 2d echo report's so better please suggest further tests to be done to confirm Azygous lobe and Heart function. As you are saying all hypertension patients with cardiomegaly should be evaluated for heart failure. What should I do further? I know that heart failure is serious but what are chances in this case? and what precautions I have to do for speedy recovery?

Answered by Dr. Drkaushal85 (18 minutes later)

Brief Answer:
Get done 2d echo and CT thorax.

Detailed Answer:

Hi,

To confirm whether it is Azygous lobe or pneumonia, best is CT scan of thorax.
To rule out heart failure, get done fresh 2d echo and stress test.
If it is heart failure then better consult cardiologist and get done clinical examination.
In that case she will have to reduce fluid intake (less than 1.5 liter/day), reduce salt intake (2-3 gms /day), diuretics (torsemide with spironolactone) and other cardiac supportive drugs.
Please let me know if she is having any breathing difficulty especially at night while sleeping.

I will be happy to help you further. Wishing good health to your mother. Thanks.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Drkaushal85 (42 hours later)

I will do the 2d echo and CT Thorax once this ongoing Pneumonia treatments over this weekend. She is not having any breathing difficulty as well. The coughing is also reduced in small quantity.

I will do the above tests and share the reports with you.

Thanks

Answered by Dr. Drkaushal85 (29 minutes later)

Brief Answer:
I will wait for your reply.

Detailed Answer:

Hi,

Yes, this is perfect.
Complete this ongoing treatment.
Get done CT scan and 2d echo.

I will wait for your reply.
I will be happy to help you further. Wishing good health to your mother. Thanks.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Drkaushal85 (13 days later)

Hi,

Visited the cardiologist and done the 2D echo, this report is normal and the cardiologist says everything is good at this place. I have also done the CT today and bit worried results are there. the report is attached herewith. please suggest.

Answered by Dr. Drkaushal85 (3 hours later)

Brief Answer:
It is highly suspicious of malignant lesion.

Detailed Answer:

Hi,

I have gone through the CT report you have mentioned.
It is highly suspicious of malignant lesion.
This is something very common now a days.
Females without smoking habit or any risk factors don't show lung cancer.
This is sad but reality.
She should undergo bronchoscopy and biopsy to confirm cancer and identify type of cancer.
She will also need PET scan to rule out distant metastases.

I will be happy to help you further. Wishing good health to your mother. Thanks.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Drkaushal85 (4 hours later)

oh no.. is this curable? If yes, what will be the timeframe to cure it completely? if not, how many days we have in hand? what are the normal charges for bronchoscopy and biopsy test? also PET scan? is this spreads rapidly? what precautions needs to take going forward? need guidance on further process.. thanks

Answered by Dr. Drkaushal85 (1 hour later)

Brief Answer:
Spread depends on type of cancer.

Detailed Answer:

Hi,

Answer to your 1st question.

It is not curable. Lung cancer is curable when it is in stage 1. She is having stage 4 lung cancer which is not curable.

Answer to your 2nd question.

There is no specific duration but 6-8 cycles of chemotherapy are advisable.

Answer to your 3rd question.

It is also not predictable. If patient is doing good with chemotherapy then patient can live for 4-5 years.

Answer to your 4rth query.

Normal charges for bronchoscopy is 7000-10000. Biopsy will charge around 1500-3000.
PET scan will cost around 18000-25000.

Answer to your 5th question.

Spread depends on type of cancer. Some cancers like smal cell, bronchoalveolar carcinoma (BAC) are rapidly growing cancers while Adeno carcinoma and squamous cell cancer are slowly progressive in nature.

So better to consult pulmonologist and get done bronchoscopy. You should also consult oncologist.
Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Prasad