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Page 2 / March 07


ANSWER:


He was born in Canada to Guyanese parents. His mother had an uneventful pregnancy and his birth was uncomplicated. The parents were last back in Guyana five years ago. There is no history of TB contact, weight loss or night sweats. He has had eczema in the past. He has a pet budgerigar at home though not in his room. There's no history of easy bruising, joint pains or abdominal pains. His immunisations are up-to-date and he has no known allergies.

On examination he was comfortable and conversational. His heart rate was 130, respiratory rate 20-30, saturations 99%, blood pressure 135/56. There was no lymphadenopathy, rash, petechiae, telangiectasia, hemangioma. He had no respiratory distress and had good air entry without additional breath sounds. Examination of his nasopharyx and tonsils were unremarkable and he did not have mouth ulcers.

He had a complete blood count with a Hemoglobin of 61 g/dL with an MCV of 75 and platelets of 308. White cell count was 13 x 109/ L with a differential of 6.78 polymorphs, 4.89 lymphocytes and 0.51 eosinophils. His hematocrit on admission was 0.17. The blood film showed mild polychromasia. Erythrocyte sedimentation rate (ESR) was not raised at 5. Ferritin was 138. INR was 1.1 with Prothrombin time of 26. A capillary blood gas was done and his pH was 7.35, pCO2 33, bicarbonate 21 with a base excess of 2. Blood electrolytes were normal.

A chest X-ray was ordered:



Figure 1-a Figure 1-b

Please describe the chest x-ray.


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