[27M] With progressive shortness of breath and neck swelling

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Patient Description

A 27-year-old male presents with progressive shortness of breath over the past three months, which is notably worse when lying flat. The patient also reports extreme neck swelling, with a sensation of fluid upon movement, and a 2-inch wide pocket of fluid or pus on the left upper back. Additionally, there is a persistent sensation of fluid in the left ear for over two months. The patient experiences chest tightness, a productive cough with clear phlegm, and occasional hoarseness. There is a history of unintentional weight loss, slight leg swelling, and chest pain exacerbated by deep breathing or coughing. The patient has a history of methamphetamine use and is currently taking Effexor 150mg and Propranolol 40mg. Previous chest imaging, including X-ray and CT scan, returned clear results. No known allergies or prior diagnoses of lung or heart conditions. No recent travel or known exposure to infections.

Arora's Assessment

What might be happening

Based on the symptoms you've described, there are several serious conditions that could be contributing to your current state:

Heart Failure or Cardiovascular Issues: The combination of shortness of breath, chest tightness, and swelling in the neck and possibly the legs could indicate heart-related issues. Heart failure can cause fluid buildup in the lungs and other parts of the body, leading to difficulty breathing, especially when lying flat.
Pulmonary Edema or Pleural Effusion: The sensation of fluid in your chest and difficulty breathing could be due to fluid accumulation in the lungs or the space around the lungs. This can be a result of heart problems or other conditions affecting the lungs.
Infection or Abscess: The pocket of fluid or pus on your upper back and the sensation of fluid in your ear could suggest an infection. Given your history of intravenous drug use, there is a risk of infections that can spread through the bloodstream, potentially affecting the heart (endocarditis) or other areas.
Lung Conditions: Chronic cough with clear phlegm and breathing difficulties could be related to lung conditions such as chronic obstructive pulmonary disease (COPD) or other respiratory issues, which can be exacerbated by drug use.
Lymphatic or Thyroid Issues: Swelling in the neck could also be related to lymphatic or thyroid problems, which may require further investigation.

What you can do

Seek Immediate Medical Attention: Given the severity and combination of your symptoms, it is crucial to seek immediate medical care. Go to the emergency room or call 911, especially if your breathing becomes more difficult or you experience chest pain.
Avoid Lying Flat: Since your symptoms worsen when lying flat, try to sleep propped up with pillows to help ease your breathing.
Monitor Symptoms: Keep track of any changes in your symptoms, such as increased swelling, fever, or worsening pain, and report these to a healthcare professional.
Avoid Substance Use: Refrain from using methamphetamine or any other substances, as they can exacerbate your symptoms and complicate your condition.
Follow Up with Healthcare Providers: After receiving emergency care, ensure you follow up with your healthcare providers for further evaluation and management of your symptoms and underlying conditions.

Remember, this advice is not a substitute for professional medical evaluation and treatment. Please seek care from a healthcare professional as soon as possible.

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3 mo ago

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