Case Fridays - An unwelcomed pulmonary Tourist

Presenting Complaint
Tony.M a 20 year old male comes to your GP Clinic. He has been unwell for the last two days since returning to Australia and this morning coughed up some yellowy-brown sputum. A persistent cough has also developed since this morning, which the patient describes as rattly and moist. He also has some mild chest pain and breathlessness (dyspnoea).

Past History
When asked has he noticed any other symptoms (e.g. aches/pains, runny nose), Tony informs you that he woke up during the middle of last night feeling hot and sweaty.  He also informs you that he has recently returned from a trip to India and Thailand for his summer vacation.

Physical Examination
38.9 C
RR: 20/min
82 bpm
128/64 mm/Hg

On auscultation coarse crackles are heard.

Investigations
An xray is ordered to aid in diagnosing the illness.

A = a normal lung     B = patient Tony.M.
InvictaHOG via Wikipedia

What is the likely overarching condition based on the current information?

How might you treat the condition?

What further tests might you order to clarify the condition?

In addition, are there any problems or things that could have been done better with Tony's x-ray?

Click here to find out.

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