Karthik Radiology Presentation.pptx

8/17/2019 Karthik Radiology Presentation.pptx

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RADIOLOGYPOSTING

CASEPRESENTATIONPRESENTER :KAARTHIGAN

RAMAIAHID NO. : 06-201204-00011LECTURER :

DR.AZMAN


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1. History taking

2. Physical examination

3. Provisional diagnosis

4. Diferential diagnosis5. Investigation

6. anagement !lan

". Disc#ssion and learning o#tcomes

$. %e&erences

'()*+)*

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Pati!t"# $tai%#

)ame , -an Dayang emi

ge , 4/ years o ld

%ace , alay

0ender, emale

ddress, *an#ng 0ading #ar

(cc#!ation, Ho#sei&e

Date o& admission, 26/42/16

Date o& clerking, 2$/42/16

'hie& com!laint

hortness o& 7reath &or 3 eeks

Hi#t&'( &) *'#!ti!+i%%!##:

Patient is a knon case o&hy!ertension and !le#ral

t#8erc#losis. Patient started tohave shortness o& 8reath 3 eeksago. he claimed that it isorsening on sitting and aking8#t not at rest. Patient also!resented ith ortho!noea and!aroxysmal noct#rnal dys!noeasince 3 eeks ago. he needs toslee! #sing 3 !illos. Patient alsoadded that she also had decreasedefort tolerance since 3 eeks ago.he said it started to orsen 2eeks ago in hich !atient claimedthat she started &eeling lethargya&ter alking aro#nd 3/ metres.

HI*(%9 *:I)0

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Patient also !resented ithon and of giddiness.Patient said that she startsto vomit and &eelsna#seated only a&ter taking

anti;*7 dr#gs. Patient saidthat she lose $/kg to 4/kgin this 3 years time.(therise !atient denied8l#rring o& vision &everco#gh chest !ain and!al!itation.

Pa#t ,$ia% i#t&'(

*#8erc#losis

Diagnosed 6 months ago

Patient is having rec#rrent !le#ralef#sion.

he has done !le#ral ta!!ing &or 16times d#e to this.

Patient as !laced #nder a

treatment regimen &or 6monthsatest 8lood !ress#re reading is1"6?/ mmHg

*aking medi cations &o r it

'om!liant

o &ar no com!lication &romhy!ertension like headache!al!itation or 8l#rring o& vision

)o :non edical Illness

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Pa#t #/'+ia% i#t&'( >oer segment caesarean

section

Done in 2//$ and 2/13 to!revent com!lications as !atienthad !revio#s history 5miscaria ge histo ry.

(ther than that no others#rgeries ere done.

D'/+ i#t&'( a!$ a%%'+( *. 'alci#m car8onate 5//mg *D

*. Pyra@inamide 5//mg +(D

*. mlodi!ine 5mg (D *. e rro#s #marate 2//mg (D

olic acid 5mg (D

Aitamin 7 11 (D

*. Isonia@id 3// mg (D

*. %i&am!icin 3// mg (D

*. Pyridoxine 5/ mg (D

*. +tham8#tol H'l 4//mg +(D

a,i%( i#t&'( ather !assed aay at the age o& 63

d#e to myocardial in&arct ion.

other is st i l l a l ive and is 62 yearsold ith h istory o& d ia8etes mel l i t#s

and hy!ertension. $ si8 l ings 5 males and 3 &emales

ith )o :non edical I l lness.

S&ia% i#t&'( Pat ient l ives in v i l lage area.

Pat ient c la imed that o!en 8#rningha!!ens constantly.

Pat ient gets a clean ater s#!!ly.

Pat ient has no &ood al lergy ando8serves a normal 8alanced diet .

Pat ient h#s8and is a smoker 8#tdoesnBt smoke in & ront o& !at ient .Pat ient is not an alcohol ic.

Pat ient also cla imed that there is no!ets in her ho#se

Pat ient c la imed that no one in her

&ami ly has *7 and also her & r iends. 5


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Patient as alert !ink and thin and eak there as acann#la inserted on the le&t hand.

ita% #i+!# , *em!erat#re, a&e8rile

7lood !ress#re, 1"6?/

P#lse rate, $5 8!m reg#lar rhythm ith normal character andvol#me.

%es!iratory rate, 16 8!m

I!#*ti&!

)o !eri!heral cyanosis no (slerCs node no ane ayBs lesion. *he !eri!hery as cold. )o con#nctival !allor and scleral a#ndice oral hygiene acce!ta8le no central cyanosis.

A not distended. )o any visi8le !#lsation o& neck.

'hest, no any chest de&ormities no any s#rgical scars and novisi8le !#lsation

PH9I'> +EI)*I()

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Pa%*ati&!

*rachea is not deviated

*he cricosternal distance is 3 Fnger 8readths

!ex 8eat is &elt at 5th intercostal s!ace along mid;

clavic#lar line'hest ex!ansion as good

*actile vocal &remit#s; increased on the right area

P'/##i&!

nterior D#ll so#nd heard on right loer @one

Posterior D#ll so#nd heard on right loer @one

"


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A/#/%tati&! 7ronchial 8reathing as heard

Decreased air entry on the right com!artment

)o rhonchi or 8asal cre!itation

*actile vocal &remit#s; increased on the right area +nd ith P+% #rine di!stick

$


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P%/'a% T/'/%i#

Positive Fndings

Previo#s history o& !le#ral ef#sions shortness o& 8reath

decreased efort tolerance

lethargy

loss o& eight

Perc#ssion revealed d#ll so#nd heard on right loer @one on8oth anterior and !osterior chest all

#sc#ltation revealed 8ronchial 8reathing decreased air entryon the le&t com!artment and tactile vocal &remit#s; increasedon the right area

P%(AII()> DI0)(I

?


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1. Pne#monia

• igns o& lo8ar or aty!ical !ne#monia s#ch as dys!noea.0enerally shorter d#ration o& sym!toms com!ared ith *7.

2. arcoidosis

• (ther &eat#res o& sarcoidosis s#ch as intrathoraciclym!hadeno!athy and arthralgias may 8e !resent.

3. #ngal in&ection

• Potential ngi incl#de histo!lasmosis coccidioidomycosisand 8lastomycosis. *ravel history may hel! narro the

diferential diagnosis

DI+%+)*I> DI0)(I

1/


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7lood investigations

I)A+*I0*I()

)ormal 7' Fnding.

Patient is slightlyanemic.

ULL 3LOOD

COUNT

RESULT REERENCE RANGE

H 1/.3gd> 11.5;15.5

TR3C 3.6 x 1/6#> 3.$;5.$

PC 31.$ G 3";4"

MC $$.$ &> "6;?6

MCH 2$.6 !g 2";32

MCHC 32.2 gd> 3/;35

PLT 2$4 x1/3#> 15/;4//

T3C $.1 x 1/3

#> 4;11

N/t'&*i% 63.6 G 5.15G 2;".5

L(,*&(t 24.2 G 1.?6G 1.5;4

M&!&(t 5.5 G /.45G 2;1/

Ei!&*i% 5." G /.46G 1;6

3a#&*i% 1./G /./$G /./2;/.1

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)ormal res#lts o&>iver #nction *est.

LIER UNCTION

TEST

RESULT REERENCE

RANGE

TOTAL PROTEIN "3 g> 65;$5

AL3UMIN 3? g> 35;5/

GLO3ULIN 34 g> 2/;35

A5G RATIO 1.1 g> 1./;2.2

TOTAL 3ILIRU3IN " #moll P *( 22.2

ALKALINE

PHOSPHATASE

$4 > 3/;12/

ALANINE

TRANSAMINASE

15 > P *( 32

RENAL

PROILE

RESULT REERENCE

RANGESERUM

CREATININE

"/ #moll 53;1//

UREA $ mmoll 2.5;$.3

SODIUM 134

mmoll

135;145

POTASSIUM 4./

mmoll

3.5;5./

CHLORIDE ?5 mmoll ?$;1/$

)ormal res#lts o&%enal ProFle.

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>DH is slightly high.(ther than that normal'ardiac +n@ymesval#es.

CARDIAC ENZYMES RESULT REERENCE

RANGE

CREATINE KINASE 53 > 25;2//LACTATE

DEHYDROGENASE

254 > 11/;24$

ASPARTATE

TRANSAMINASE

13 > P *( 4/

CALCIUM 2.16 mmoll 2.1;2.6INORGANIC

PHOSPHATE

1./ mmoll /.$";1.45

COAGULATION RESULT REERENCE

RANGEPT 11."/ ?.56 11./5

INR 1.14

APTT 36.2/ 2?.5 4/.?

)ormal res#lts o&'oag#lation ProFle

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Ple#ral K#id sam!le &or examination


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I0I)0


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*aken on 2642/16

indings

P vie 'h est E;ray.

*aken in erect !osit ion ith no rotation and the F lm is adeL#ately!enetrated.

*he F lm is adeL#ately ins!ired and the l#ng F eld is clear. *he cardiacthoracic ratio is M5/G.

7ilateral l#ng hilar visi8le ith 8l#nted right costo!hrenic angle ithradio;o!acity loer @one o& r ight l#ng.

>#ng is hy!erinKated and the trachea is central ly located and nodeviation. )o consol idation and no sign o& air #nder dia!hragm.

*here is no ortic ne#rysm no dilated !#lmonary tr#nk normal

heart orientation no dextro;cardia and the a!ex is located in the le&t.

Im!ression D#e to 8l#nted costo!hrenic angle and radioo!acity there might 8e a K#id

collection

)o cardiomegaly.

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1"


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*aken on 2"42/16

indings

P vie 'h est E;ray.

*aken in erect !osit ion ith no rotation and the F lm is adeL#ately!enetrated.

*he F lm is adeL#ately ins!ired and the l#ng F eld is clear. *he cardiacthoracic ratio is M5/G.

7ilateral l#ng hilar visi8le ith 8l#nted right costo!hrenic angle ithradioo!acity loer @one o& r ight l#ng.

>#ng is hy!erinKated and the trachea is central ly located and nodeviation. )o consol idation and no sign o& air #nder dia!hragm.

*here is no ortic ne#rysm no dilated !#lmonary tr#nk normal

heart orientation no dextro;cardia and the a!ex is located in the le&t.

Im!ression D#e to 8l#nted costo!hrenic angle and radioo!acity there might 8e a K#id

collection

)o cardiomegaly.

1$


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2642/16 2"42/16

'(P%I()

1?


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I0I)0


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*aken on 1622/16

indings

Image L#ality is degraded 8y 8reathing arte&act.

*here is moderate amo#nt o& !le#ral ef #sion noted in the

right hemithorax. *he K #id is homogeno#s in density hich meas#res M2/H.

)o !ockets o& air or so&t tiss#e mass ithin the ef #sion.

*he !le#ral lining is homogeno#sly thin and non;enhancing. *here is a colla!se consolidation o& the medial segment o& the right

middle lo8e and 8asal segment o& the right loer lo8e ith air

8ronchograms.)o l#ng mass seen in the right l#ng.

)o l#ng nod#le or cavitating lesion seen in the right #!!erlo8e or the rest o& the middle and loer lo8e.

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)o &ocal lesion in the le&t l#ng.

Heart is enlarged. )o !ericardial ef#sion.

*he vis#alised liver is enlarged. )o &ocal liver lesion

)o signiFcant enlarged lym!h node in the #!!er

a8domen. *he !ancreas gall8ladder and adrenal glands are

normal.

Im!ression

'olla!se consolidation right middle lo8e and 8asalsegment o& the right loer lo8e ith moderate !le#ralef#sion. )o l#ng mass or cavitating lesion.

'ardiomegaly.

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PH%'(>(0I'>,

%ecommendation on d#ration o& +P*7 treatment 8y -H(are,;

N regimen sho#ld contain 6 months o& ri&am!icin, 2H%O+4H%

)0++)* P>)

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(thers,;

1. trict I( chart

2. l#id restriction

3. -eigh daily

4. %eg#lar +

5. trict 8edrest

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#mmary

It is a 4/ years old alay &emale ho is a knon case o&hy!ertension and also !le#ral t#8erc#losis ho as admittedd#e to shortness o& 8reath &or 3 eeks hich as associatedith ortho!nea decreased efort tolerance !aroxysmal

noct#rnal dys!nea lethargy giddiness and loss o& eight.Patient is an non;smoker and non;alcoholic.

(n !hysical examination her !#lse rate as in reg#lar rhythmith normal character and vol#me. (n !al!ation tactile vocal&remit#s; increased on the right area. (n !erc#ssion d#ll so#nd

as heard on right loer @one. (n a#sc#ltation 8ronchial8reathing as heard decreased air entry on the rightcom!artment tactile vocal &remit#s; increased on the right area.

E ray F nding, r ight loer @one ef #sion

>+%)I)0 (*'(+ )DDI'I()

D+I)I*IA+ DI0)(I, P>+%> *7+%'>(I25


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2"


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2$


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2?


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3/


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Ple#ral *7

Q In cl inical !ractice #ltrasonogra!hy


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8dominal *7

*he imaging modal it ies most ly #sed in the investigation are '* and8ari#m st#dies.

Q *he diagnostic yields &or the dif erent modal it ies are $3G &or 8ari#mmeal &ollo thro#gh $/G &or '* and ""G &or .

Q eat#res s#ggestive o& a8dominal *7 are ascites


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*H): 9(

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Karthik Radiology Presentation.pptx

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