Concluded Case

difficult in breathing on/off SOB, lower back pain,

26/y female c/o pain in ribs and difficulty in breathing un able to sleep on supine position due to lower back pain with on/off SOB, since 1 month, feeling generalised weakness, body pain, fever for few days and head ache since one week.... No cough, no abdomen pain, non DM2, non HTN No any surgery.. H/O pulmonary Cox, Was on ATT 3 years back VITALS BP:110/70 mmhg PR: 99 to 110 Chest: clear no wheezing Abdomen: soft non palpable Spo2: 97% on room air INVESTIGATION : whole spin MRI Done attached documents in image, chest x-ray is normal, mantoux test done showed 20mm indurations, PFT also done Can i suggests patient to start ATT based on mantoux test... Please 🙏 need opinions and suggestion from our great doctors pannel, How to manage the cases, what further treatment and management needed for this cases.

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Concluded answer

MRI Dorsal spine shows abnormality from D6 to 9 and suggested contrast MRI. Do contrast MRI for further diagnosis. Rib pain probably radicular pain and not exactly in the rib probably from the spine.Lying down position the pain is aggravating that again shows pain from dorsal spine.post the films of MRI plain and contrast for further discussion. .

All Answers

Multiple issues Positive points noted 1 past h/o ATT 2 h/o fever body pain generalised weakness 3 MT is positive 4 MRI suggest infective pathology in dorsal spines d6 to d9 likely tubercular 5 desication of disc at L4L5 with thecal sac indentation and narrowing of spinal canal 6 PFT suggest obstructive pulmonary disease All these findings suggest Pt has active infective lesion likely tubercular needs further workout and to restart ATT Lumbar spondylitis suggest spinal canal stenosis which can be managed by surgery in better way So to streamline the management better hospitalise and form a team of experts to manage.

Thanx dr Kute Ankush
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MRI Dorsal spine shows abnormality from D6 to 9 and suggested contrast MRI. Do contrast MRI for further diagnosis. Rib pain probably radicular pain and not exactly in the rib probably from the spine.Lying down position the pain is aggravating that again shows pain from dorsal spine.post the films of MRI plain and contrast for further discussion. .

Thank you @Manorama Rajan madam garu?
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Thank you doctor
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? SPINES PATHOLOGY .. MANTAUX TEST .. 20 mm .. POSITIVE .. NEED'S .. CLINICOPATHOLOGICAL EVALUATION WITH .. SPINE SURGEONS OPINION ..

Tnx Dr Shivraj Agarwal sir
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CHEST X-RAY NORMAL . SO HOW'S DIFFICULTY IN BREATHING ,AND PATIENT SUFFER FROM LOWER BACK PAIN . IT'S MANTOUX TEST WAS POSITIVE . I THINK IT'S SPONDYLITIS ?? ADVICE FOR CHEST HRCT TYPICALLY CORONARY INFECTION SUSPECTED ? MILD SEVERITY?? REFER TO NEUROLOGIST?

I do not suggest ATT try to find out cardiac and hemogram Hb calcium and review more about dorsal spine

Spine pathology Multiple discs prolapse Ad Decompressive Surgery Discotomy of discs Ref patient to a spine specialist for surgery

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