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
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
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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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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HEART DISEASE can turn the nail beds red....... ** If the NAIL BED is RED, it could be caused by a high content of fatty acids and cholesterol, due to an excess of dairy products, sugar and salt in the diet. This can lead to an underactive liver and blocked arteries....... To keep the system healthy by replacing refined foods with wholegrain rice and bread, and flush out the system with plenty of fresh vegetables and at least five glasses of water a day....... *** HALF PINK and HALF WHITE nails can be a sign of kidney disease....... *** BRITTLE NAILS :- CAUSES : AGING. CHEMICAL/TOXIN EXPOSURE. LONG-TERM USE OF NAIL POLISH AND POLISH REMOVE. LOW HUMIDITY ENVIRONMENT. MALNUTRITION. NAIL-PATELLA SYNDROME. PROLONGED EXPOSURE TO WATER. TRAUMA. ** B complex vitamins (especially biotin), calcium, and zinc have all been implicated. There are other medical conditions which can cause brittle nails such as ANEMIA (low blood count), THYROID DISORDERS, and skin disorders such as LICHEN PLANUS and PSORIASIS. ** ONYCHOSCHIZIA includes splitting, brittle, soft or thin nails. Onychoschizia is MORE COMMON IN WOMEN. Only VERY RARELY are INTERNAL DISEASE or VITAMIN DEFICIENCIES the reason (IRON DEFICIENCY is the MOST COMMON).......Dr. Puranjoy Saha39 Likes36 Answers