Endgames Case Report

Cough and weight loss in a young man

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f4537 (Published 01 August 2013) Cite this as: BMJ 2013;347:f4537
  1. S J Chavda, core medical trainee year 1 doctor,
  2. A Shepherd, foundation year 1 doctor,
  3. C Hasford, consultant in acute medicine
  1. 1Department of Acute Medicine, University College London Hospital, London NW1 2BU, UK
  1. Correspondence to: S J Chavda selinachavda{at}doctors.org.uk

A 28 year old man was referred to the emergency department by his general practitioner after presenting with a two day history of haemoptysis. He described coughing up a teaspoon of fresh blood in the morning after a month of coughing up rusty coloured sputum. This was on a background of eight months of persistent cough associated with progressive lethargy and weight loss, with isolated episodes of night sweats. His travel history showed no exposure to high risk areas for tuberculosis or HIV, and he denied any high risk behaviours for contracting HIV. He had never smoked.

On chest examination, he was found to have an area that was dull to percussion over the right parasternal region and normal breath sounds throughout his lung fields. The rest of the examination was normal.

His observations were heart rate of 90 beats/min, blood pressure 110/85 mm Hg, respiratory rate 20 breaths/min, oxygen saturations 100% on room air, and temperature 36.9°C. Blood results showed a haemoglobin of 136 g/L (reference range 133-167), white blood cell count 10×109 cells/L (3.5-11), and C reactive protein 55 mg/L (0-5 mg/L; 1 mg/L=9.52 nmol/L). Urea, electrolytes, and liver function tests were normal.

Routine chest radiography was performed in the emergency department. This showed an anterior mediastinal mass.

Biopsies were then taken from the mass. These showed Reed-Sternberg cells.


  • 1 What is the diagnosis?

  • 2 What is the differential diagnosis of an anterior mediastinal mass?

  • 3 What other signs and symptoms can patients with this condition present with?

  • 4 What is the …

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