Finally hi everyone, time to present the final outcome in this case, Based on the CT scan findings of cystic cavities, Lt lung , grossly compensated RT lung as evidenced by the pseudo herniation of RT lung into the Lt hemi thorax, young age with recurrent problem since childhood, a diagnosis of congenital cystic bronchiectasis of Lt lung with? Hypoplastic Lt lung was made and further investigations done. Cardiac evaluation to rule out RT heart failure/ Pulmonary hypertension was done which was normal. Fob showed e/o mid LMB narrowing but beyond that obstruction branch and segmental opening normal with moderate thick secretions present. BAL neg for AFB . After adequate preparation he was taken up for pneumonectomy. Surgery was uneventful with pt recovering in a week , icd removed in 2days . Hpe report enclosed. Totally no e/o TB . This case is presented for 2 reasons Not all chest inf are Tuberculosis Surgical option can provide a definite cure in many of the cases
I agree with Dr.S.P Sanjeevaiah.
Is it diaphragmatic hernia? soon I realized that the mefiastinal shift to the same side is against this. Does the CT scan suggest bronchiectasis. I thought the classical tram line sign is not there.
This is a classical case of cystic bronchiectasis - non tubercular. There are lot of congenital causes for same. You may do a pft , BAL analysis and culture and treat underlying infection with appropriate antibiotics. He must be managed at a higher (tertiary ) centre
Left destroyed lung probably due to old healed infection with shift of mediastinum and herniation of right lung to left side. D/D hypoplasia of left lung
Destroyed fibrosed cavitated volume lost left lung That is post tubercular bronchiectasis super added sec infections and sometimes haeptysis is very common in such a lung This leads to clubbing also and sometimes sec renal amyloidosis also appears leading to nephritic syndrome type pic.. In some pts due to less resp reserve this may turn to rt hrt failure
MDR/XDR tuberculosis.Xray showing fibrocavitory lesions in left apical and mz.Trachea pulled toward left.Left lower zone fibrosis.Should be investigated at higher center for sputum culture, HIV and other immunocompromised states.Till then to be treated symptomatically.
CXR shows fibrocavitatory lesion in the left lung. Trachea has been pulled to left side because of the fibrosis. Approach as a case of MDR/XDR TB. Investigate further for TB. Treatment mainly symptomatic at present and to be started with inhaled corticosteroids, mucolytics.
Old healed cavitatory destroyed left lung. Advised for Gram stain, CBC, Sputum microscopy and if Sputum is negative for AFB than CBNAAT test is to be done.
fibrocavitory lasions on left side with mediastinal pulling ... Should be investigated for MDR tuberculosis...repeatedly. continue respiratory management as a case of COPD....interstitial lung disease. Inhalational corticosteroids and As n when needed ...go for antibiotics mucolytics in acute phase of the illness ...sos admission. High protein diet and breathing exercises.
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35 yrs old male please give opinion about collapse in this caseDr. Purushottam Sinha13 Likes40 Answers
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ABC OF : NAIL DISORDERS. ( I ). MAY BE USEFUL. *** ANONYCHIA is the absence of nails, an anomaly, which may be the result of a congenital ectodermal defect, ichthyosis, severe infection, severe allergic contact dermatitis, self-inflicted trauma, Raynaud phenomenon, lichen planus, epidermolysis bullosa, or severe exfoliative diseases....... *** PSORIASIS can also affect the fingernails and toenails, leading to thick fingernails with pitting, ridges in the nails, nail lifting away from the nail bed, and irregular contour of the nail....... *** LICHEN PLANUS of the nails can cause brittle or split nails, and the affected nails may have ridges running lengthwise....... *** FUNGAL nail infections are common infections of the fingernails or toenails that can cause the nail to become discolored, thick, and more likely to crack and break. Infections are more common in toenails than fingernails.....by some dermatophytes, Candida (Monilia) species, etc....... The technical name for a fungal nail infection is “ONYCHOMYCOSIS.”....... *** SPOON-SHAPED or spooning fingernails refers to a concavity in the fingernail itself, resulting in a depression in the nail that gives an appearance of a spoon shape to the entire nail. This growth disturbance in the nail is known as KOILONYCHIA....... In particular, koilonychias is associated with IRON DEFICIENCY. *** Fingernails are made by living skin cells....... So a skin condition such as eczema may lead to fingernail ridges. Skin dryness can also cause these ridges. If the body is low in protein, calcium, zinc.......or vitamin A, a deficiency can sometimes be revealed by ridges in the fingernails. ** HORIZONTAL RIDGES run from side to side on nails and are often referred to as BEAU'S LINES may be a sign of previous injury, underlying health conditions, or in rare cases, arsenic poisoning....... Horizontal ridges can be caused by trauma to the nail and may be deep or discolored. The can also indicate malnutrition, psoriasis or a thyroid problem....... ** VERTICAL RIDGES are usually harmless and a consequence of ageing.......nail injury, or trauma, or underlying medical conditions....... *** The ECTODERMAL DYSPLASIAS (EDs) are genetic disorders affecting the development or function of the teeth, hair, nails and sweat glands....... ** ED is not a single disorder, but a group of closely related conditions of which more than 150 different syndromes have been identified....... *** Nail CLUBBING, also known as digital clubbing, is a deformity of the finger or toe nails associated with a number of diseases, mostly of the heart and lungs. ... Hippocrates was probably the first to document clubbing as a sign of disease, and the phenomenon is therefore occasionally called "Hippocratic fingers"..... ** Lung cancer is the most common cause of clubbing. Clubbing often occurs in heart and lung diseases that reduce the amount of oxygen in the blood. ... Heart defects that are present at birth (congenital) Chronic lung infections that occur in people with bronchiectasis, cystic fibrosis, or lung abscess....... *** While the NAIL BITING and picking seems to be such a common problem, the psychological and medical research does not agree on the exact motivation for the action. However, it suggests that nail biting can be the result of STRESS, VARIOUS MEDICAL DISORDERS, LEARNED BEHAVIORS, OR JUST PLAIN HABIT....... *** SPLINTER HEMORRHAGES : They run in the direction of nail growth. They are named splinter hemorrhages because they look like a splinter under the fingernail. The hemorrhages may be caused by tiny clots that damage the small capillaries under the nails. Splinter hemorrhages can occur with infection of the heart valves (endocarditis)....... *** YELLOW TOENAILS in an infection by a fungus that attacks the nails..... or, in some cases, they may be a sign of skin cancer. 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