September 29, 2009

Sudden onset SOB with pleuritic chest pain

a 40 years old Malay man with known case of TB suddenly develop shortness of breath associated with left sided pleuritic sided chest pain





1) Describe the findings in the above X-ray
2) What is the most probable diagnosis?
3) Outline your management to this patient



For answer & discussion to this question please click [here]

6 comments:

  1. 1-there are consolidation area at the right side of the lung..pleural space seem contain liquid..
    2-empyema secondary to tuberculosis
    3-give antibiotics(xigt dh apa ab dia..huhu)

    so,apa skema jwpn dia??

    ReplyDelete
  2. you got it wrong pal. try to look harder. dont give up. i'll post the answer and disccussion later

    ReplyDelete
  3. well, I never seen this before,
    ~_~

    Maybe pneuomothorax, but i don't see the lung become smaller.

    the dark area on the lung indicate presence of liquid right?

    The heart seems to shift to the right from its original position,
    maybe due to pressure from the left lung.

    Even the right hemidiaphragms was elevated, or the right hemidiaphragms was pushed downward

    For tuberculosis shouldn't it be opacity in the area of lung apical?
    So I don't think its tuberculosis.

    well, I'm just a second year medical students, just trying to learn here..

    ^_^

    ReplyDelete
  4. Nice try adibah,

    well this is a pneumothorax and the left lung is collapsed . that's why you can not appreciate it.

    in x-ray we used term radio-opaque (white) and radio-lucent (black). so in according to densities it will appear from radio luscent to radio-opaque in this following manner;gas, fat, fluid, bone and metal densities

    so the dark area that u see is actually a massive pleural gas.

    i agree with you that the left hemi diaphragm is slightly depressed when we count it base on anterior rib.

    for TB, you have to re-revise it. apical TB usually indicate re-activation of TB. new tb should be at the primary focus. but in this case, it is post TB. probably the TB already healed. just the scar leaved by it more easily broke

    dont worry, you are doing just fine..

    ReplyDelete
  5. syukran jazilan Akhi Naim..
    ^_^

    Thanks 4 reminding me of primary and 2ndry TB.
    I just remember my PBL case recently where there is radio-opaque at the apical part of the lung.

    so in his case, the diagnosis is broken scar from healed TB?

    what is the best management?

    ReplyDelete
  6. I'm 55-year-old from Paris, I was diagnosed with second-stage liver cancer following a scheduled examination to monitor liver cirrhosis. I had lost a lot of weight. A CT scan revealed three tumors; one in the center of my liver in damaged tissue and two in healthy portions of my liver. No chemotherapy or radiotherapy treatment was prescribed due to my age, the number of liver tumors. One month following my diagnosis I began taking 12 (350 point) Salvestrol supplements per day, commensurate with my body weight. This comprised six Salvestrol Shield (350 point) capsules and six Salvestrol Gold (350 point) capsules, spread through the day by taking two of each capsule after each main meal. This level of Salvestrol supplementation (4,000 points per day) was maintained for four months. In addition, I began a program of breathing exercises, chi exercises, meditation, stretching and stress avoidance. Due to the variety of conditions that I suffered from, I received ongoing medical examinations. Eleven months after commencing Salvestrol supplementation But all invalid so I keep searching for a herbal cure online that how I came across a testimony appreciating Dr Itua on how he cured her HIV/Herpes, I contacted him through email he listed above, Dr Itua sent me his herbal medicine for cancer to drink for two weeks to cure I paid him for the delivering then I received my herbal medicine and drank it for two weeks and I was cured until now I'm all clear of cancer, I will advise you to contact Dr Itua Herbal Center On Email...drituaherbalcenter@gmail.com. WhatsApps Number...+2348149277967. If you are suffering from Diseases listed below, Cancer, HIV/Aids, Herpes Virus,Bladder cancer,Brain cancer,Colon-Rectal Cancer,Breast Cancer,Prostate Cancer,
    ?Esophageal cancer,?Gallbladder cancer,Gestational trophoblastic disease,Head and neck cancer,?Hodgkin lymphoma
    ?Intestinal cancer,Kidney cancer,Leukemia,Liver cancer,Lung cancer,Melanoma,Mesothelioma,?Multiple myeloma,?Neuroendocrine tumors,Non-Hodgkin lymphoma,Oral cancer,Ovarian cancer,?Sinus cancer,Skin cancer,Soft tissue sarcoma,Spinal cancer,Stomach cancer,Testicular cancer,Throat cancer,Thyroid Cancer,?Uterine cancer,Vaginal cancer,?Vulvar cancer,Hepatitis, Chronic Illness. Lupus,Fibromyalgia.

    ReplyDelete

Ya Allah! Permudahkanlah aku untuk menuntut ilmuMu, memahaminya, mengingati dan menyebarkannya. Berkatilah ilmu itu dan tambahkanlah ia. Amin.