c/o dry cough on n off wich relieves on medication since 2 yrs.sputum AFB negative.dx n D/Ds

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For proper inspiratory film 9 ribs should be countable posteriorly.. So not truly inspiratory.. But one thing for sure that left diaphragm is raised.. Cardiac size should not be evaluated in a expiratory film.. As it gives an impression of enlightenment.. So i commented probably... X-ray chest is not showing any parenchymal lesion in the chest.. So with 2 year history any structural defect in the lung as a cause of cough is almost ruled out
Enlargement not enlightenment
D/D of chronic cough.. Dailated cardiomyopathy as heart shadow looks enlarged.. Other cardiac diseases... Needs echocardiogram Other causes like G e reflux Cough variant asthma Post nasal drip are other common possibility List Of uncommon and rare cause is long........
sir is it nt expiratory film ? ur expert opinion regarding that..
Expiratory cxr repeat xr than can be commented.
how old patient is? wether is he on anti hypertensives ? some anti hypertensives like ACE inhibitors cause nasty dry cough n many times confuse treating physician who goes on looking for otger reasons , also see if there are basal crepitatiins heard? than it may be because of cardiac reasons , do IGE level n see absolute eosinophil levels also , may be allergic also , there is no gross lung disease , its sure from x ray
*basal crepititions

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left dome of diaphragm elevated... if dry cough rule out Gerd and achalasia cardia.... treat with PPI and proline tics also u could try montelukast 10mg bd... Plz get ct chest for completion
PPI and prokinetics

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Chronic cardiac disease with upwards of left side diaphragm gastric reflux with oesophagus allergic bronchial asthma.
Elevation of left done of diaphragm can be due to event ration , collapse of left lower lobe , phrenic n palsy etc.
chest x easy is normal you must sent blood for eosinophil count and if it is normal then do HRCT of thorax.
Raised left diaphragm is also to be evaluated... Normal variant or left lower lobar segmental collapse...
COPD lt basal effusion tapping fluid for cbnat cardiomegaly 2 decho hrct pft then decide
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