Chest Xray - Things you might miss

A 76 years old male patient admitted to the medical casualty ward with low-grade fever for 2 days with rhinitis and cough. He was on losartan for hypertension. His grandchild also has had similar symptoms a couple of days back.

On examination the lungs were clear.

WBC - 7.6, Hb 11.8, Plt 234, RBS 92, CRP 4.2



How will you manage the patient?

 Well, the upper respiratory tract infection will settle on its own. You might not have to do anything. If there is an epidemic of influenza you may use oseltamivir.

 Chest Xray shows some features of hyperinflation. So, take a history of smoking and other exposure. If the patient has exertional SOB you can manage as COPD.

 But, if you look carefully, chest Xray also shows a rib that's too white! What is it? That's due to sclerotic bone mets, probably from a prostate carcinoma.

Comments

Post a Comment

Popular posts from this blog

2 min read - Cirrhosis

Image
A 55 years old male patient admitted to medical casualty with a febrile illness for 3 days with myalgia. Examination was unremarkable. He was previously well except for chronic bilateral knee joint osteoarthritis. He consumed liquor quarter to half a bottle on a daily basis. Investigations revealed. WBC - 5.6 Hb - 11.2 Plt - 135 AST - 45 ALT - 42 S.Cr - 54 He was managed as viral fever and became fever free the next day. However the platelet count was persistently low around 130. Further investigations arranged. Blood picture - Thrombocytopenia probably due to liver disease S. Bilirubin, ALP - Normal S. Albumin - 38, S globulin - 37 USS abdomen - Coarse echogenicity of liver. Mild portal hypertension. Mild splenomegaly. Compatible with chronic liver cell disease. This patient has Cirrhosis with portal hypertension. Now the obvious cause for his cirrhosis is alcohol, isn't it? NO! Just because of the history of significant alcohol consumption you ca
Read more

2 min read - Tachyarrhythmias

Image
A 32 years old previously healthy male patient admitted with a history of palpitations for 1 hour duration. He had experienced a similar episode a few months back which lasted only for few minutes. What are your concerns? First priority is to make sure that the patient is stable. Who is unstable? Hypotensive patient (Systolic BP < 90mmHg) Coronary ischemia (Ischemic chest pain) Cardiac failure (Patient has SOB) Patient with brain hypoperfusion (reduced conscious level) IF ANY OF ABOVE ARE PRESENT IRRESPECTIVE OF THE TYPE OF ARRHYTHMIA YOU WILL HAVE TO PERFORM DC CARDIOVERSION (SHOCK) ECG Analysing tachyarrhythmias is a long topic, which might bore you. Let's learn a few short cuts to diagnose common arrhythmias. Look at the QRS Is it narrow or broad? Narrow complex tachycardias we usually encounter are SVT (Read and understand the proper nomenclature. SVT is a wrong term!) Atrial fibrillation/ flutter In most patients both are managed the s
Read more