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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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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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. 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