74 year old man admitted with weight loss, Nausea and vomiting, Rt hip pain.

He has been under investigation for weight loss of 18 kg in last 3 months.

Back ground history showed

1. COPD on Inhalers for many years
2. Ex smolers (stopped 16 yeras)
3. MI 1999 4.planned for total hip replacement by ortho.

On examination, he appeared well and alert apart from a thin body with scaphoid abdomen. Neuro, CVS, Resp and abdo exams nil significant. No leg oedema.

Recent OGD and Colonoscopy showed nothing.

FBC and U&E normal

CA 199 and CA 125 borderline high

T4 (15.5)normal and TSH (0.18) slightly low.

Sputum AFB pending.

We requested for CT (abd and thorax) Any comment?

Update: 10/12/2009:

Today endocrinologist suggested that low TSH is not uncommon among patient with chronic disease. Advised to do Free T3. If normal, endocrine input no longer required. T3 came back as Normal. Today CT done, awaiting formal report.

Update: 11/12/2009

CT Thorax and Abdo report came back with 2 significant issues.

1. Pleural thickening of both upper lobes, forming to a mass.
2. A significant dilation of lower part of oesophagus extending to oesophato gastric junction.

Patient denied any asbestos exposure in his life. Next, it is debatable that there is a dilatation of oesophagus on CT scan after an experience gastroenteroligist's OGD finding was NAD. Any way, we requested Barium meal to confirm that finding. For pleural thicking, the respiratory physicain will come and have a look.

to be updated:::