27 yr old male presented with complaint of breathlessness and cough with expectoration from last 1month and chest pain from last 10 days.Patient took AAT for 9 months last yr. He has history of recurrent pnemonia since childhood. ECG and X-ray attached.

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Excellent discussion amongst all I can see this case as a case of congenital deformities 1. Wherever chest deformities are present chances of congenital heart disease are increased. 2. History of childhood cough is very important here, that suggest increased pulmonary blood flow condition in childhood , these are ADD,VSD, AND PDA. That is supported by presence of Harrison sulcus on lateral chest picture again suggest ccf in childhood and isolated ASD will not cause ccf in that age group so we have two things remain 3. Nails shows more than grade 3 clubbing and I m doubting cyanosis here 4. X ray chest lung parenchyma destructed due to repeated lung infection 5. ECG is suggestive of severe PAH So we are dealing with VSD/PDA with rt to left shunt ( eissenmenger) Echo would be required to see the the two things

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Yes pegion shape chest with rotation and old thin walled cavity with fibrosis and lossof lung volume on rt side thrahea is pulled to rt and fresh infiltrates are also seen rt upper and mid zone looks to be reactivation of old pultb should be investigated for MDR. He is pale as nails present with 4th degree clubbing . Tillkochs is confirmed give him broadspectrumantibiotics likeAmoxyclav625mg 1x2times and tab pulmoclear1x2times and expectorants.

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Pegion Chest Scoliotic deformity of chest with loss of lung volume on right side Clubbing points to chronic Hypoxia due to restrictive disease Trachea pulled to right with fibrituc right lung field pointing towards old healed infective etiology

This case came out to be bilateral pulmonary tuberculosis healed ( sputum negative , cbnaat MTb not detected , sputum for afb smear and culture negative from JALMA) with congenital heart disease ? TOF . Cause of pectus carnatum can be recurrent infection

If childhood history of recurrent lrti than TOF is difficult to explain
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Barrel chest.Fingers clubbing with anemia.Xray chest Changes of copd ashama with mediastinal shift to right side,Fibrotic changes on right side with cavity.Pulmunory tuberculosis sequele

Piegon chest Scoliosis Old healed lesion rt up zn Trachea p@ulled to rt Clubbing is xue to old repeated pul lnfecyions Recent one is acure exerbation of old patho

There is pigeon chest with old pul tuberculosis with vsd There seems lt to RT shunt With plethora lung field due to pul hypertension So consider for sildinafil and endothelin receptor antagonist And mild diuretic also apart from antibiotics bronchodilator and if needed akt

There is a fibrosis inrt. Upper lobe,scoliosis seen,healed cavities seen,Echo of this pt.shows VSD RVHand TR this pt. may have reactivation of pul.tuberculosis first of all repeat investigation like sputum for AFB CBC,ESR,and confirm diagnosis,more over this pt.having RVH& TR soshould have diuretic along with AKT for MDR tuberculosis.good nutritive diet, multivitamins,expectorant with broncodilater

Pegion chest. Rotation ++ Thin walled cavities and scarring Rt.upp.lung Old healed PTB.

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