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Assembly

Nodules, Nodules – More to it than Meets the Eye

Author
Srikant Kashinath Malegaonkar, MD
Post Graduate Institute of Medical Education and Research, Chandigarh


Case

A 60-year-old gentleman with well controlled type 2 diabetes mellitus presented to the clinic with an episode of streaky haemoptysis. There were similar episodes of streaky haemoptysis in the past (about two episodes per year in the last three years) which would resolve with oral tranexamic acid within two to three days. There was no other significant history apart from one of his co-workers being treated for sputum positive tuberculosis. Vitals and physical exam were within normal limits. Laboratory results including complete blood count and coagulation profile were within normal limits. Induced sputum stain, culture and Xpert MTB/RIF were negative. Contrast enhanced computed tomography of chest along with high resolution parenchymal cuts of lung are depicted below.

Contrast Enhanced CT and Parenchymal Cuts of Lung

Question

What would be the next best step in the management of the above patient?

A. Start empirical anti tubercular treatment
B. Bronchoscopy and sampling from abnormal areas
C. Computed tomography pulmonary angiogram
D. Continue oral tranexamic acid and observe

Which among the following are other presentation/s of the above disease?

A. Septal thickening
B. Pleural effusion
C. Tracheobronchial plaque
D. All of the above

Answer