Intended for healthcare professionals

Endgames Case Review

A guttural cough

BMJ 2021; 372 doi: (Published 13 January 2021) Cite this as: BMJ 2021;372:m4977
  1. Kathryn McCarthy, consultant colorectal surgeon1,
  2. Shoba Philips, consultant radiologist2
  1. 1Department of General Surgery, Southmead Hospital, Bristol, UK
  2. 2Department of Radiology, Southmead Hospital, Bristol, UK
  1. Correspondence to KM: kathryn.mccarthy{at}

A man in his 50s presented to his general practitioner with a four month history of persistent, guttural cough. The cough prevented him from completing sentences. He was a non-smoker and had no other symptoms. Chest examination by his GP was normal.

At a GP follow-up one month later the patient described increasing breathlessness and tiredness. Haemoglobin was measured at 122 g/L (normal adult male range 130-180 g/L)1 and chest radiography showed clear lungs and pleural spaces.

During this time, the patient attended a National Bowel Scope screening programme for a flexible sigmoidoscopy. This was reported as “all clear.” He had no gastrointestinal symptoms.

Two months later, the patient was still unable to speak in full sentences and requested a respiratory consultation. Chest radiography was reported as normal and a computed tomography scan was requested (see fig 1). Haemoglobin was measured at 96 g/L.1

Fig 1

Computed tomography scan of the chest …

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