12 yr old female pt. presented with h\of recurrent bouts of chronic cough for past 2 yrs ,each episode lasting for 10-15 days and subsiding on its own.Cough is so severe as to interrupt her sleep.Each episode is initially associated with hemoptysis whose severity decreases in 4-5 days.She also complains of dyspnoea onmild to moderate exertion.There is no h\of weight loss nor has she any signs of malnutrition on examination.Physical examination is not contributory.Even there are no signs of pulmonary involvement on exam..Chest X-Ray shows milld hilar prominence.Hb is 12.4gm%,TLCis 8400,Dlc is P57%,L39%,E04%,absolute eosinophil count is 360 cells,bronchialwashings show aerobic cocci,and budding yeast cells.There is no response to antiallergic or bronchodilators.
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Rule out cardiac disease such as mitral valve involvement. Also since she has hemoptysis, rule out pulmonary hemosiderosis. In this case send the BAL or sputum for macrophage laden hemosiderin analysis. Also rule out bleeding disorder. If all is negative, a CT chest with angiography may be required to rule out an arteriovenous malformation.
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