Case history
Case history
A 39-year-old man presents for the third time in 2 years (to different physicians each time) for evaluation of an intermittent productive cough and increasing dyspnoea on exertion. He has a 15 pack-year smoking history, reports thick, yellow phlegm at times and describes having trouble keeping up when playing with his children. His medical history reveals mild intermittent asthma controlled with a salbutamol inhaler. His symptoms have persisted despite stopping smoking, and his asthma exacerbations have increased in frequency, with some attacks being unresponsive to salbutamol. Physical examination reveals a generally healthy-looking male. During the examination he experiences coughing with subsequent wheezing on auscultation and a long expiratory phase. Cardiac examination is normal. Spirometry demonstrates an FEV1 of 40% of his predicted value.
Other presentations
Patients with pulmonary manifestations may also present with fatigue, chest tightness, and/or exercise intolerance. Patients with hepatic manifestations may present with jaundice, scleral icterus, abnormal liver function tests, fatigue, asterixis, hepatic encephalopathy, bleeding/bruising, and/or oesophageal varices. Hepatocellular carcinoma presents with worsening liver function, abnormal liver imaging, rising alpha-fetoprotein levels detected in blood serum, and sometimes pain.
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