A Growing Problem

A CLINICAL PROBLEM-SOLVING article by Wendy Yeh from Brigham and Women's Hospital, Boston.
A 36-year-old pregnant woman at 21 weeks of gestation presented with a 4-week history of a dry, nonproductive cough.
She had no fever, chills, dyspnea, chest pain, or weight loss. It was her first pregnancy, and there were no complications. She had no new pets, environmental exposures, or sick contacts. In the past, she had traveled to Australia, Central Asia, and sub-Saharan Africa.
Her cough improved, but did not resolve, with the use of an inhaled bronchodilator. Her symptom persisted for another month, and she was started on an H2-blocker for empirical treatment of gastroesophageal reflux disease. She continued to use an H2-blocker for the remainder of her pregnancy. She had an uncomplicated vaginal delivery 4 months later. She continued to have intermittent dry cough and presented again 2 months after delivery for a reevaluation of her cough.
A chest radiograph revealed a soft-tissue mass, 7 cm in diameter, adjacent to the right heart border.
This patient had an uncommon cause of a common symptom.
This case illustrates the importance of not ignoring a growing problem, even if the presentation seems benign.