The Case of the Man Who Exsanguinated in His Doctor's Office

Albert B. Lowenfels, MD

Disclosures

March 29, 2013

The Case

The patient was a 59-year-old man who had enjoyed robust health until about 1 year before his death, when he developed progressive fatigue and weakness. This was accompanied by difficulty in breathing and pain in the chest. He consulted several physicians without receiving a definite diagnosis. His weakness became progressively worse, as did his shortness of breath.

About 12 hours before his death, the patient coughed up a small amount of blood. He went to see his local practitioner, where he suddenly coughed up a huge amount of blood; within a few minutes, he exsanguinated and died.

Physical and Medical History

The patient's height measured 5 feet, 5 inches, and his habitus was stocky. The most prominent physical finding was a difference in the strength of the radial pulses: The left pulse was normal, but the right pulse was noticeably weaker.

The patient had had no prior illnesses or hospitalizations. He also had had no known fevers, weight loss, or cough before his final illness. About 1 year before he died, he fell forward while rapidly descending a steep, rocky slope, which caused severe, widespread bruises.

Family and Social History

There were no known familial diseases. When the patient was 8 years old, his father died after an injury while felling a tree. The patient drank alcohol occasionally and was a smoker. For most of his life, he worked as a guide and had many years of military service.

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