An acute 76-year-old patient became invasive because of Ventilation with the suspected diagnosis of "acute exacerbated chronic obstructive pulmonary disease (COPD)" was presented in the emergency room.
In the clinical examination, we found breathing noise that was weakened on the right side, and radiologically space-occupying (tension) pneumothorax was shown. Immediate relief by means of chest drainage was used. The computer tomography performed two days after the patient was admitted showed pronounced changes in the pulmonary framework with several masses (Figure).
After an extended anamnesis it turned out that the patient suffered from silicosis. The patient was further treated in intensive care, the subsequent diagnosis revealed multiple brain metastases and an adrenal gland mass, so that presumably bronchial carcinoma was present on the basis of the silicosis. The patient eventually died of pneumonia-related septic multiple organ failure.
The symptom "dyspnea" includes broad differential diagnosis even with pre-existing COPD. Patients must be screened for serious complications, especially pneumothorax, because this requires immediate intervention and can potentially be made worse by non-invasive ventilation.
Dr. med. P eter Korsten, Clinic for Nephrology and Rheumatology, University Medical Center Göttingen, email@example.com
Prof. Dr. med. Sabi ne Blaschke, Interdisciplinary Emergency Department, University Medical Center Göttingen
Conflict of interest The authors declare that there is no conflict of interest.
Citation: Korsten P, Blaschke S: A 76-year old man with COPD and acute dyspnea.Dtsch Arztebl Int 2016; 113: 824. DOI: 10.3238 / arztebl.2016.0824
@The German version of this article is available online: www.-international.de