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Hemoptysis

UnFiNiShEd CaSe CoMe BaCk LaTeR

History of Present Illness:

A female in her 80’s with a history of atrial fibrillation on Xarelto was sent to the ED by her PCP for a hemoglobin of 9.6. She denies any melena but  has been feeling a bit lightheaded for over 2 months ago. She denies any vomiting, chest pain, shortness of breath. She does have a slight sore throat today and did cough once and had some blood in it.

Vital Signs & Physical Exam:

Vital signs are normal except for

Physical exam is otherwise normal except for guaiac positive dark brown stool

Initial Diagnostic Testing:

  • CBC: normal except for Hb of 9.2, normocytic
  • Chem 7: normal except for
  • Imaging: none

What is the most likely diagnosis?

  • A) Pneumonia
  • B) PE
  • C) Pulmonary hemorrhage
  • D) Lung cancer
  • E) COVID

SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT

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ANSWER:

  • A)
  • B)
  • C)
  • D)
  • E)

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

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CASE CONCLUSION: EGD on  mild gastropathy with flecks of blood in the antrum, status post biopsies, normal duodenum, recommended to resume Xarelto, no suspected upper GI bleed, daily PPI.
Anemia work-up with iron 18, ferritin level less than 10 concerning for severe iron deficiency anemia.
CT chest with multifocal atypical pneumonia predominantly involving the right lung
Repeat H&H 8.4/25.8. While in the hospital patient received 2 doses of IV iron.

 

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