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Inflammed lung issue - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Lung and Chest disorders
Answered by

General & Family Physician
Practicing since : 2009
Answered : 681 Questions
User :   My daughter has been sick for approximately 5 weeks now, at first we assumed that is was some sort of flu but she continues to get sick and shows no signs of improvement, and so far the doctors are unable to reach any sort of definitive diagnosis, and I was hoping for some sort of guidance in what should be looked into…
-     Hx- Previously health 10 year old girl who has always been tiny but that is consistent with my family she is 4’2 and previously weighed 45lbs, no health concerns.
-     She has experienced a severe loss of appetite and has lost 9lbs (now weighs 36 lbs.) and sometimes has a sore throat when she eats and sometimes gets a stomach ache (not consistent with any type of food-random), we push food and fluids as much as possible but she states she is not hungery
-     Fatigued with minor excursion which is worsening she is unable to go to school and cannot handle more then 30-45 minutes of mild activity without exhaustion
-     Her colour varies from pale to very pale upon activity and is sometimes a grey colour, more recently in the last 24 hours minor signs of oral cyanosis (blue colour)
-     Vitals show oxygen saturation is not always satisfactory and has varied between 88%-97%, resting heart rate is 105-110 and increases to 120-135 upon mild excursion, blood pressure and temperature within normal limits
-     Chest x-ray shows small amount of fluid in lungs and auscultation revels minor crackles in bases
-     CBC normal – no increase in WBC’s as would be expected with infection though platelets are slightly raised 541 (norm 400), and the radiologist who read the xray says it is not pnemonia
-     Cough that comes and goes and within the last 24 hours has began to produce white frothy sputum in copious amounts
- We have been told that it is not pnemonia... based on the xray
Doctor :   Hi,
User :   hello
Doctor :   Let me read your query for few minutes to be able to have a good discussion here.
User :   ok thank you
Doctor :   History was very informative,
Doctor :   Was she having episodes of raised temperature any time in recent past ?
User :   She had a low grade fever one time over the past 5 weeks and it has been taken at least once per week
Doctor :   Was she treated with any antibiotics ?
User :   yes
Doctor :   ok, was the central cyanosis all the time or would become evident when ever she was exerted on breathless ?
User :   it has only started last evening after we had been out getting more blood work (so upon exersion)
User :   and it did resolve once she was resting
Doctor :   ok, Does she have problems related to urination ?
User :   no bowel and bladder habits are normal
Doctor :   ok, according to the history , i too feel the infective( pneumonia) cause being the second possible diagnosis
Doctor :   the first to be considered and ruled out would be cardiac ( heart ) pathologies
Doctor :   and that could be done by a 2D echocardiography
User :   So it would be quite possible that the pnemonia is a sequale and there is something else going on..
Doctor :   The basal crepitations in the lungs o auscultation and the fluid in the bases are typical of it being a transudate
User :   transudate meaning?
Doctor :   Transudate means a fiterate from the blood .( the fluid in the lungs ) oozed out due to pressure differences in the blood vessels of the lungs
Doctor :   the counterpart is exudate which is fluid produced by inflammed lung issue ( seen in pneumonia )
User :   So increased pressure as in it could indicate pulmonary edema which would indicate that there could be a heart pathology?
Doctor :   you are right ,
Doctor :   that can explain the reduction in the Oxygen saturation , the central cyanosis , basal crepts and the fluid in the basal parts of the lungs
User :   and now the white frothy sputum? and could have caused the possible pnemonia?
Doctor :   frothy sputum is again typically seen in pulmonary oedema , sometimes pink
User :   and the lack of appitite and weight loss? caused by just overall not feeling well?
Doctor :   pneumonia is one where there would be copious amount of sputum from the beginning of the infection
Doctor :   lack of appetite , could be due to overall illness Fatigue which is due to cardiac problems again , will induce weakness and decreased thirst for energy
User :   ok and I was wondering if it would be valid to investigate that she has complained of a sore throat and I was wondering about an infection that had started there and then travelled to the heart..
Doctor :   yes, still i have the infection second in my list
Doctor :   a HR Ct scan can answer this
User :   ok so the beginning of the investigation should be the 2D echocardiography, and HR Ct
Doctor :   yes, you got it right
User :   ok thank you is there anything else I should consider
Doctor :   let me not put you into load
Doctor :   i strongly consider one amongst the cause i mentioned to be the diagnosis here
Doctor :   the CT scan will help you there
Doctor :   which will rule out most of the lung causes which can present this way
User :   I just have one more question I also realized as I watching her eat there seems to be more coughing and sputum and the amount is really increasing
Doctor :   that could be due to throat irritation caused by food which is triggering the cough
User :   ok that makes sense you have been very helpful thatnk you
Doctor :   you are welcome
Doctor :   kindly provide your feedback
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