HistoryChief complaint: Pain and swelling in left breast.
HPI: 47 y/o male admitted for w/u of L chest wall mass 1/30/1997. While watching TV on January 22 experienced pain below his L nipple. 3/10 constant dull ache. He did not think much of it until two days later when on the 24th he noticed the development of swelling at the site of pain. The patient is confident that the mass was not present before and grew between Thursday to Monday. It had become tender to touch with a slight red and blue discoloration inferiorly. Nothing made the pain go away and pain increased with raising of the arm.
ROS: Never followed with a physician. Non-productive cough for months with one episode of blood tinged sputum, no appetite for one mo, and a 16lb wt. loss in the last 1.5 mo. He recalls easy fatigability and DOE without change in activity level. He reports sleeping more often, falling asleep anytime of the day. He denies any other CP, F/C/D, or night sweats. He denies exposure to animals, TB or recent travel.
Medications: No medications
PMH: None; no surgery; no transfusions
Allergies: No medications
Family Hx: Mother died age 63 cirrhosis + ETOH; father died age 50 cause unknown; 4 brothers, 3 sisters A/W; patient is the youngest in family
Social and occupational Hx: Smoker 30p/yr. He is still working 40 hrs/wk as a bartender. Divorced, helped raise 2 children; T ppd age 17; ETOH 2 beers/night; Marine Corps 68-'70: Vietnam + Combat; exposure to Agent Orange; Worked setting marble x 14 years s/p '90
Patient perspective: "This has something to do with my smoking and I know I can't fix it on my own."