The Lung - A Man's Pain and a Woman's Instinct

 Yesterday afternoon, an elderly lady, CLK rang me up to thank me profusely for referring her husband, FK. to a Respiratory Physician at the General Hospital. She was relieved that a diagnostic and confirmatory investigation was performed on him and now awaiting a laboratory result for definitive treatment.

FK is a fit 74 year old man who was a Vice-President of an international resort. He exercises at the gym almost daily and is not a smoker. He always prides himself in being able to keep up with young people at his age. Both he and CLK are active members of their church. I caught him self-medicating on an anti-diabetic drug for a number of years and had managed to  persuade him to be on  my  Diabetes clinic follow-up. He always gives the impression that he is healthy and that nothing is wrong with him except for his sinus. If possible he would avoid a doctor like the plague!

About two weeks ago the couple turned up at my clinic without an appointment. According to CLK three nights before coming to see me, FK woke up from his sleep with an excruciating pain on the left side of his rib cage. They called up their regular private doctor and were told that it was not a heart attack. Apparently the pain was relieved by a warm pack and panadol. His doctor also gave him a course of antibiotic as he felt feverish the next day. FK did not have anymore pain after that and his fever had subsided but his wife felt something was not right and decided to see me.

When asked how he was feeling, FK answered confidently that he’d never felt better. There was no more pain and he slept like a baby following the episode which he attributed to muscular sprain. He  also blurted out that his wife was being paranoid.

After getting a further history of his complaint, I proceeded to examine his respiratory system and my auscultation (examination via stethoscope) of his chest revealed a reduced air entry  and  there was a dull percussion (tapping) on his left lower chest. I decided to order a chest x-ray. And I am posting the image below:

Left pleural effusion has been confirmed by CT-Scan

One look at the X-ray I could see that the left lung was abnormal in term of size and position. It looked like there was a space-occupying material pushing his lung away from the pleura (the side of lung nearest to the rib cage). He needed to have a CT-scan of his thorax (chest) to determine  and confirm the nature of the X-ray abnormality  of the left lung. His right lung appeared normal.

I referred him to my colleague in the hospital respiratory unit with a request that he himself see the patient. Cutting the story short, the scan showed the presence of fluid in the abnormal space .in medical jargon, the condition is referred to as pleural effusion. A diagnostic tap was done and more than one liter of straw coloured fluid was extracted and a sample sent for laboratory diagnosis.

Well there are several causes of pleural effusion such as chronic infection, immune diseases and abnormal cell growth (cancer).The result has not come back and I am praying for FK and his loving wife.

A woman’s instinct is often amazing.