AN INTERESTING CHEST X RAY FOR DISCUSSION V MU Prof.Dr.J.SANGUMANI M.D,D.Diab Dr.R.SUNDARAM M.D., Dr.K.S.RAGHAVAN M.D,D.Diab

CLINICAL PRESENTATION 50 yrs old female presented with C/o acute onset breathlessness 2 days No postural/diurnal variation MRCC grade 5 h/o cough with expectoration x 2 day No h/o fever No h/o chest pain/palpitations/excessive sweating/arm pain No h/o vomiting

CLINICAL PRESENTATION NO H/O TRAUMA NO H/O HEMOPTYSIS NO H/O EXPOSURE TO TOXIC FUMES NO H/O LOSS OF WEIGHT/APPETITE NO H/O SWELLING OF LEGS/PUFFINESS OF FACE/REDUCED URINE OUTPUT NO H/O ABDOMINAL PAIN/ABD. DISTENSION

PAST HISTORY TREAMENT HISTORY NOT A KNOWN DIABETIC/HYPERTENSIVE/ASTHMATIC/COPD/CAD/THYROID DISORDER NO H/O SIMILAR EPISODES IN PAST NO H/O PREVIOUS SURGERY POST MENOPAUSAL STATE TREAMENT HISTORY H/O im injection 1 day back for cough and cold

EXAMINATION Patient drowsy Obeys oral commands No pallor No icterus No clubbing No pedal edema No generalized lymphadenopathy No goitre No External markers of tuberculosis

VITALS 120/min PR 130/80mmhg BP 78% with 02 by mask SpO2 38/min RR

EXAMINATION RESPIRATORY SYSTEM Trachea in midline No chest or spinal deformity Apical impulse Left 5 th IC space ½ inch medial to MCL BILATERAL WHEEZE PRESENT ACCESSORY MUSCLE WORKING DYSPNEA +

CVS – S1 S2 PRESENT NO MURMUR JVP NOT ELEVATED P/A – SOFT NO ORGANOMEGALY CNS – DROWSY OBEYS ORAL COMMANDS B/L PUPIL 3MM ERTL

INVESTGATIONS ROUTINE BLOOD INVESIGATIONS – NORMAL ECG – NORMAL

TREAMENT GIVEN O2 BY MASK 6L/MIN INJ.HYDROCORTISONE 200MG IV STAT INJ.DERIPHYLINE 2CC IV STAT INJ.PHENIRAMINE MALEATE 22.5mg IV STAT SALBUTAMOL NEBULIZATION INJ.ADRENALINE 0.5MG IM STAT

AFTER TREATMENT PATIENT IMPROVED SYMPTOMATICALLY PR 120/MIN BP 150/90mmhg Spo2 – 94% with oxygen RR – 30/min

CHEST XRAY

LATERAL VIEW