05-17-2007, 05:27 PM
A 67-year-old man is evaluated because of a chronic, productive cough with frequent exacerbations characterized by purulent sputum and hemoptysis of 20 years™ duration. The productive cough dates back to an episode of childhood pneumonia. He has never used tobacco and has no other significant medical history.
On physical examination, his vital signs are normal. Other than coarse crackles in the left lower lung field posteriorly and laterally, the remainder of the examination is normal.
Chest radiography, complete blood count, and serum immunoglobulins are normal. Pulmonary function studies show a mild restrictive pattern without response to an inhaled bronchodilator. High-resolution computed tomography shows marked bronchial dilation with lack of normal tapering in the distribution of the left lower lobe. Bronchial walls are thickened. The remaining lobes of the lungs are normal.
Two months later he is evaluated for an episode of fever, cough, and purulent sputum of 3 days™ duration. Chest radiography is unchanged. Levofloxacin is prescribed. In the ensuing 2 days, he has a single episode of hemoptysis of 10 mL volume.
Which of the following additional management options is most appropriate for this patient?
( A ) Add ceftazidime, intravenously
( B ) High-resolution computed tomography
( C ) Sputum cytology
( D ) Fiberoptic bronchoscopy
( E ) Reassure the patient and continue present therapy
On physical examination, his vital signs are normal. Other than coarse crackles in the left lower lung field posteriorly and laterally, the remainder of the examination is normal.
Chest radiography, complete blood count, and serum immunoglobulins are normal. Pulmonary function studies show a mild restrictive pattern without response to an inhaled bronchodilator. High-resolution computed tomography shows marked bronchial dilation with lack of normal tapering in the distribution of the left lower lobe. Bronchial walls are thickened. The remaining lobes of the lungs are normal.
Two months later he is evaluated for an episode of fever, cough, and purulent sputum of 3 days™ duration. Chest radiography is unchanged. Levofloxacin is prescribed. In the ensuing 2 days, he has a single episode of hemoptysis of 10 mL volume.
Which of the following additional management options is most appropriate for this patient?
( A ) Add ceftazidime, intravenously
( B ) High-resolution computed tomography
( C ) Sputum cytology
( D ) Fiberoptic bronchoscopy
( E ) Reassure the patient and continue present therapy