Pathology case study 1

Pathology Case Study Clinical Correlation and Investigation

On this page, you can check Pathology Case Study and know how to investigate it. With the introduction of clinical cases as a method of learning pathology.a new dimension has been added to enliven the field of “basic pathology” by directing the learner to “applied pathology” in relation to clinical problems.

The brief discussion of the clinical correlation of each case follows an analytical and rational approach to solving the clinical problem, with due importance attached to each character in the medical history, examination findings, or other data provided. This concludes with a likely clinical diagnosis. What follows is an approach to systematically investigate the case. In general, this screening scheme starts with some basic pre-screening tests that are performed in almost all cases listed as “screening tests”. “Additional tests” follow to help confirm the diagnosis. However, the details of the disease given in the diagnosis are not repeated here, but reference is made to the relevant page of the textbook for further explanation and investigation.

Pathology Case Study Scenario:

A 46-year-old man has been admitted to the hospital ward with shortness of breath, loss of weight and appetite, and slight fever in the past few months. He has been smoking bidis for 25 years and has reported productive coughing with foul-smelling sputum and occasional hemoptysis for the last 15 years. During those years he had two episodes of bronchopneumonia.

When examined, he is poorly built and poorly fed. His pulse is 90 per minute, his breathing rate is 45 per minute and his blood pressure is 130/90 mmHg. He has paleness ++, jaundice +, step oedema + and grade II clubbing of the fingers. Rhonchi and crepts can be heard during the auscultation of the breast.

1. Discuss the clinical correlation with the pathogenesis of the features.
2. What is the probable diagnosis?
3. How will you investigate and confirm the diagnosis?

Clinical Correlation :

A major clinical feature of a longstanding productive cough in this adult male smoker for 25 years is due to chronic bronchitis, which over a period of many years, has led to bronchiectasis and hence foul-smelling expectoration for so many years. Interspersed haemoptysis can occur in bronchiectasis due to bleeding of friable inflamed mucosa although it requires further investigations to rule out lung cancer.

Two earlier episodes of pneumonia are due to bacterial infections causing consolidation which are common in such patients. His current presenting feature of fever is also due to bacterial infection of the lung parenchyma. Shortness of breath and increased respiratory rate are due to impaired pulmonary function from damaged lung parenchyma in COPD. Rhonchi and crepitations reflect damaged airways containing secretions.

Clubbing of fingers is due to chronic hypoxia for many years. Weight loss and anemia are due to systemic features of chronic infection; mild icterus is owing to mild liver dysfunction. Pedal edema is due to hypoproteinaemia which could be due to proteinuria since long-standing chronic infectious and destructive condition like bronchiectasis can cause secondary amyloidosis.

Probable Diagnosis

Bronchiectasis with nephrotic syndrome, possibly due to secondary systemic amyloidosis


Screening tests:

i) CBC (haemoglobin, counts, indices), ESR, PCV, blood smear for the type of anaemia.

ii) Urine examination (albumin, glucose, microscopy).

iii) Biochemical estimation: Renal function tests (urea, creatinine, BUN), liver function tests (bilirubin, ALT, AST, alkaline phosphatase, total proteins and AG ratio), blood glucose, lipid profile.

iv) Blood culture.

v) Sputum (culture, cytologic examination, Gram’s stain and tubercle bacilli).

vi) X-ray chest. vii) Ultrasound examination of the abdomen.

Additional tests

  • Bronchoscopy along with cytologic and/or biopsy material.
  • Pulmonary function tests.
  • 24-hour urinary proteins.
  • Abdominal fat aspiration for amyloid.
  • Renal biopsy for secondary amyloidosis.

I hope you tried to guess the Answer to this Pathology Case Study (Case 1)

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