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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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!

Yes it has pigeon chest and old thin walled cavity and fibrosis...right side lung thrahea tends to right side ..... expected again pneumonia with Koch's disease .......better to follow cefpodoxime and pottasium clavulanate tab twice daily upto 14 days , fexofenadine and montelucast tab once daily upto regularly , Tosq LS syrup , regular....Glacex cap , 1 cap at bedtime

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

He has features of Marfans syndrome wide arm span / clubbing of fingers / chest x ray features of copd/ asthma/ does he have high arched palate / murmur of aortic incompetence/ chest x ray widened mediastinum / ground glass appearance

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

Rickets Pigeon shaped chest But this is very tall having Clubbing both hands What is the height like

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

patient is having chest wall deformity leading to recurrent pneumonia

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