Question

A 15-year-old girl with a history of mild asthma has had worsening episodes of cough, wheezing, and increasing bloody sputum over the past 5 months. She denies any weight loss, decreased appetite, lethargy, or unusual travel. She has increased her bronchodilator use, but she has not sought further care until now. Her mother has also noted occasional facial flushing with sweating that sometimes appears when she feels stressed, but not always. They were of brief duration at first, but seem to be lasting longer now. On exam, her respiratory rate is 32 breaths/min. with obvious respiratory distress, temperature is 98.6, heart rate 84 bpm and BP 114/76, oxygen saturation is 94%. Her throat is clear and on auscultation, breath sounds over the left hemithorax are diminished without retractions or wheezes, there are few fine crackles at the base. Right side is clear. The remainder of the exam is normal. Chest X-ray reveals a round area of increased opacification near the right hilar region. Complete blood count shows a normal white count and differential. Based on this information, what is the most likely diagnosis?

1. Pulmonary embolism
2. Bacterial pneumonia
3. Bronchial carcinoid tumor
4. Pulmonary hemosiderosis
5. Unrecognized vascular malformation

Answer 1

The most likely diagnosis for the 15-year-old girl is pulmonary hemosiderosis, a rare condition characterized by episodes of alveolar hemorrhage and iron deposition in the lungs.

Step-by-step explanation:

Based on the symptoms and examination findings, the most likely diagnosis for the 15-year-old girl is pulmonary hemosiderosis. The worsening episodes of cough, wheezing, and bloody sputum, along with the presence of crackles on auscultation and diminished breath sounds on the left hemithorax, indicate a lung disorder. The chest X-ray revealing increased opacification near the right hilar region further supports this diagnosis. Pulmonary hemosiderosis is a rare condition characterized by episodes of alveolar hemorrhage and iron deposition in the lungs, leading to respiratory symptoms and abnormal radiographic findings.