43 yo male came to the ER with severe SOB and coughing. Toxic and mildly feverish lethargic. Decreased air entry spo2 80.% crepits with wheezes. This is his CXR ! Opinions, please.

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Reversely placed film. Bil multiple rounded opacities seen. Bil diffuse parenchymal heziness seen. Possible DDs Staph species causing bronchopneumonia Extensive PTB Viral pneumonia Fungal pneumonia Secondaries Leading to ARDS.

Completely agreed
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Diffuse and discreet floppy infiltrates bilateral Rt basal paracardiac density is cavitory lesion Pulmonary tuberculosis D/d fungal pneumonitis b/l

Thanx dr Dinesh Gupta
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Multiple bilateral alveolar shadows representing ARDS(acute respiratory distress syndrome) due to? 1)H1N1 -send throat swab, culture and sensitivity 2)acute pancreatitis if patient alcoholic send amylase, serum lipase, usg abdo pelvis 3)Sepsis send blood culture and sensitivity, serum procalcitonin, serum lactate, complete hemogram ,4)CKD -send RFt, send Bnp to rule out heart failure and do ecg, management -watch for spo2 and pao2, Start NIV trial if not improve intubation ,give hydrocortisone 100mg Iv stat, give lasix 20mg Iv stat then according to bp, Broad spectrum antibiotics, ivf, Nebulisation with duolin and budecort

POSSIBLY.... A. R. D. S...DUE. TO ASPERGILLOSIS METASTASES / MALIGNANCY P. TB ADVISABLE.... USG AND ALL. RELEVANT. INVESTIGATIONS

*ARDS ** PTB ** MALIGNANCY NEEDS FURTHER INVESTIGATIONS AND EVALUATION TO CONCLUDE DIAGNOSIS AND TREATMENT PLAN.

Thanks Dr Dinesh Gupta
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ARDS may be due to H1N1 Aspergillosis Kochs Uremic lungs O2 inhalation NIV support Broad spectrum antibiotics Bronchodialtors Steroids Nebulisation with Duolin 3 times in First hr after that 8hrly Neb with budesonide 12hrly Other supportive treatment acording to need Thanks

ARDS...following Aviation Flu. Get through virological investigation to be performed.. Broad spectrum antibiotic..

Bilateral patchy lesions? PTB?? Fungal?? Malig CT thorax /Sputum for AFB

Multiple opacities with haziness seen in both lung fields.d/d: Mets, bronchopneumonia, ARDS, PTB.

Bilateral bronchopneumonia with left basal collapse

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