Dr. Amol Kumar Wasudeorao Diwan
Allergy Specialist
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I am suffering from chronic dry cough originating primarily in bronchial area. I feel fatigue, vertigo, lack of appetite and periodic nausea. Please help.
Hello,
Welcome to icliniq.com. Chronic cough since long time suggests some allergic condition like asthma. For proper diagnosis you should do a chest x-ray and spirometry test. Other symptoms can be suggestive of someinfective cause like tuberculosis. So, ultimately after an x-ray and spirometry test we can make a definite diagnosis. Vertigo can be because of chronic cough. But, clinically it is very difficult to say. Some blood test may also be required for making a diagnosis. Usually, the asthmatic patients have some other allergies also. You have not specified any other symptoms in detail. Please do not hesitate to contact me after doing the above mentioned tests. Treatment mainly depends on the reports. The probable causes may be allergy. Investigations to be done are chest x-ray and spirometry test. Differential diagnosis is asthma. Treatment plan include inhaler medicines. Preventive measure include avoiding known allergen.
Patient's Query
Hi doctor,
Thank you so much for your rapid reply. I had not included the results of my recent computed tomography (CT) scan conducted a month ago, which isolated two nodules in the right lung (6 and 7 mm) with numerous nodules 3-4 mm in the superior right and left lobes some of which are calcified. There has been no significant change in the size of these nodules over the last few years. I have included the report. I also had a spirometry test conducted six months back and the results are also attached. My medical history and current symptoms are also attached for reference. I have a local pulmonologist who is conducting exams, however since this is a challenging case I am now reaching out to international basis for further expertise and opinions. My wife is a medical doctor and we have jointly identified a list of possible diagnoses but would be interested in your opinion. Of interest to a differential diagnosis, I had a severe case of eosinophilia before 30 years and which was unfortunately never diagnosed.
Hello,
Welcome back to icliniq.com. I have gone through all your reports and medical history (attachment removed to protect patient identity). I will try to interpret in accordance with your chest problem. Though the thoracic computed tomography (CT) scan is showing some nodules, I do not find any significance pertaining to present illness. But, we cannot ignore it. So, CT guided biopsy can be done for definite diagnosis as we cannot deny tuberculosis also. With the background of loss of appetite, night sweat and fatigue all this points towards tuberculosis. Also you have mentioned about excision of schwannoma in past so metastatic nodules is also a possibility. Coming to your spirometry report, it is absolutely normal. So, the possibility of asthma is also ruled out. Eosinophilia is not a disease, but suggests some underlying disorder if it is persistent. Coming to the treatment, I suggest you to try Flovent 250 inhaler (Fluticasone Propionate) two puffs twice daily with spacer or holding chamber empirically and see what is the difference in your symptoms. But, only after ruling out tuberculosis. Ultimately, I recommend to do a histopathological diagnosis of the lung nodules by CT guided lung biopsy. After which we can start definitive treatment.
Patient's Query
Hi doctor,
Thank you for your response. We are planning to implement the diagnosis recommendation you have proposed that is the histopathological diagnosis of the lung nodules by computed tomography (CT) guided lung biopsy. I will revert back to you as soon as possible.
Hi,
Welcome back to icliniq.com. Please let me know after the final diagnosis is done. Take care.
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Allergy Specialist
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