1. 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

2. 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

3. 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

4. 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

5. 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

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

7. 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 +

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

9. INVESTGATIONS
ROUTINE BLOOD INVESIGATIONS – NORMAL
ECG – NORMAL

10. 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

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

12. CHEST XRAY

13. LATERAL VIEW