Clinical case: non-productive cough at bedtime, disappears upon rising

CLINICAL CASE

A 75-year-old man with a diagnosis of biliary adenocarcinoma started, during his stay at the hospital, with a non-productive cough when lying down, but stopping when standing up.

This symptom appeared after  the drainage of a liver abscess. No fever, dyspnea or thoracic pain was present.

 The physical examination detected a right basal pulmonary hypoventilation related  with a moderate pleural effusion.

CLINICAL EVOLUTION

The patient was fine without dyspnea, cough or expectoration. He always referred the same symptom, a non-productive a permanent cough, when he was laid down. At the end the CAT scan showed the presence of a right pleural effusion moving to the mediastinum. After a thoracocentesis the pleural effusion was removed and the cough stops definitively.

We show here at the next picture the presence of the pleural effusion moving to the mediastinum. 

COMMENT

There are cough receptors scattered in the respiratory tract, usually around the main bronchus and the mediastinal area, and it is well known that the presence of tumors or enlarged nodes produces a similar situation of non-productive cough when the patient lies down, due to the compression of these receptors, a situation that in some textbooks is called “mediastinal syndrome”.

TEACHING POINTS

Some symptoms are not dangerous for the patient, but they can be very disturbing. Imagine going to sleep and suddenly starting with a non-productive and continuous cough. The doctor has the responsibility  to pay attention to every detail of the patient and to use his or her knowledge to clarify them and to help the patient.