45 yes old male pt admitted for fever.. X ray chest taken. . X ray findings? differential diagnosis? how to proceed further? plz share your views. .

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This is a case of 45 years old patient with fever., ? miliary tuberculosis. X ray chest shows miliary mottling of both lungs What is the duration of fever? Is there any history of cough? Any history of allergy ? History of occupation is also important Any history of worm infestation. Differential diagnosis 1Miliary tuberculosis 2 Sarcoidosis 3 Tropical pulmonary eosinophilia 4 Coal miner's pneumoconiosis 5 Acute extrinsic allergic alveolitis 6Fibrosing alveolitis 7 Fungal diseases like Histoplasmosis Blastomycosis coccoidomycosis Cryptococcosis 8 Miliary carcinomatosis due to metastasis of carcinoma of breast thyroid pancreas prostate Melanoma 9 Lymphoma 10. Pulmonary hemosiderosis 11 silicosis 12 siderosis 13 Pulmonary edema 14 Fat emboli 15 Multifocal pneumonia Investigations CBP FPG PPG HBA1C RFT Fasting lipid profile TFT serum electolytes LFT Absolute eosinophil count Pulmonary function tests X ray chest CT chest Sputum for AFB, and fungi,pyogens Bronchoscopy CUE ECG lung biopsy if needed A detailed history clinical examination investigations occupational history Residential history past history of pulmonary koch's, immunosuppressed History of smoking and alcohol Family history Examination of respiratory system CVS Abdominal examination CNS Opthalmological examination Dermatological examination Locomotor and rheumatological examination Depending on all and size, distribution of lesions in xray chest clinches the diagnosis Miliary mottling more in upper lobes in miliary tuberculosis Mottling is more in upper and mid zones in sarcoidosis and pneumoconiosis If the size is less than 2mm,we find them in miliary tuberculosis, fungal infection, coal workers pneumoconiosis If the size is more than 2mm, miliary carcinomatosis, sarcoidosis, tropical eosinophilia, Multifocal pneumonia should be suspected I answered what I know Dr suresh, you must detail the case .
nice one...
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XRay showing bil lung infiltrates most likely patient is in ALI. requires CBC,RFT,LFT,Urine R ,blood c/s, fever profile (dengue, MP,lepto etc) , PS. May be sepsis or Viral fever(diverse etiologies), DSS/DHF,Malaria,Rickettsia,LRTI,HIV positive. Infective endocarditis,bone & joint infections,Abscesses(hepatobiliary, diverticular,Pulmonary,CNS,). management - take care of ABC, IV fluids, keep watch on platelet count & PCV, IV antibiotics ,maintain adequate urine output, w/f renal failure, liver failure, supportive Treatment.
its difficult to give all DDx without history sir. Vast number of conditions r there.
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proper history and physical exam then investigation cbc esr mp widal urine complete Lft etc
Thanks sir
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What is occupation looks like occupation lung disease silicosis
Thanks sir
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marvellous explanation and discussions madam. .whole chest medicine covers in a single wonderful answer..Thanks a lot madam. ..
U R most welcome dear Suresh
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Is it Extrinsic allergic alveolitis or hypersensitivity pneumonitis dear Suresh as you said the patient is a farmer
pt was admitted on yesterday madam. .I'll update the investigations report once it comes madam. .Thank you so much for ur efforts and interest madam. ..
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dd nicely given by tirumala mam
Thanks Dr Shailesh
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x ray chest PA view
Occupation. .Farmer