Differential of this case.. Wegeners granulomatosis Bronchiectasis Tuberculosis Arteriovenous malformation bronchogenic carcinoma.. Send p-anca and C-Anca.. Sputum for AFB smear and bactec culture..
Causes of HAEMOPTYSIS 1.Bronchgenic carcinoma -smoker,age>40,recurrent non massive hemoptysis, weight loss. - physical finding(PF)-local chest wheezing. 2.Acute Pneumonia -Historical clue(HC) -acute fever,productive cough,pleurisy,rusty brown hemoptysis -PF -fever,focal coarse chest crackles,bronchial breath sounds. 3.Chronic bronchitis/Brochiectesis -HC- frequent copious sputum production, frequent 'pneumonias'. -Scattered , bilateral coarse crackles, wheeze,clubbing. 4.Heart Failure -HC-orthopnea, lower extrimity edema, history of valvular heart disease/CAD. -PF-Murmurs,S3,Loud S1 or P2. 5.TB,Fungal lung disease,Lung abscess - HC-Travel & exposure history, -PF- fever,coarse crackles,cachexia. 6.Vasculitis, hemorrhage syndrome -HC- subacute constitutional symptoms, hematuria,rash,arthralgias. -PF-diffuse chest crackles,mucosal ulcers, rash. 7.Pulmonary embolus -Acute dyspnoea , pleurisy. -PF-Hypoxia,Pleural rub,unilateral lower limb edema(DVT). 8.AVM/hereditary hemorrhagic telangiectesia - HC -Platypnoea,epistaxis,Family h/o similar signs & symptoms. -PF-Mucsal telangeictesias, orthodeoxia. in this case , possibility of heart failure, pneumonia & bronchitis is more. CXR is showing prominent bronchovascular markings & cardiomegaly. advised investigations- -Echo -BNP -sputum AFB,Fungal,cytology,routine & gram stain. -ANA/ANCA screen,anti GBM antibodies. if required FOB and Bronchial & Pulmonary arteriography.
60 YEARS OLD MALE PATIENT WITH COUGH AND DYSPNEA SINCE 10 DAYS WITH EPISODE OF HEAMOPTYSIS MODERATE KNOWN HYPERTENSIVE ON ANTI PLATELETS APT CAN BEVA PRECIPITATING FACTOR FOR HEAMOPTYSIS
Clinical picture is of pneumonitis with haemoptysis aggravated by antiplatelets
there is some consolidation seen on right side.... it is close to hilum... ccf is less likely as left side looks pretty clear and even the bases are clear.... kindly mention the auscultatory findings... sputum culture, fever , looks like pneumonia...
consolidation in rt up lobe with cardiomegaly infective etiology more likely do sp afb gram stain culture do cbc pt inr
hocm with ccf. hemoptysis agravated by anti platelet drug. .
it seems to be pulmunory congestion....as may be ccf....
drug induced thrombocytopenia,; 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. The can also indicate malnutrition, psoriasis or a thyroid problem....... ** VERTICAL RIDGES are usually harmless and a consequence of ageing.......nail injury, or trauma, or underlying medical conditions....... *** The ECTODERMAL DYSPLASIAS (EDs) are genetic disorders affecting the development or function of the teeth, hair, nails and sweat glands....... ** ED is not a single disorder, but a group of closely related conditions of which more than 150 different syndromes have been identified....... *** Nail CLUBBING, also known as digital clubbing, is a deformity of the finger or toe nails associated with a number of diseases, mostly of the heart and lungs. ... Hippocrates was probably the first to document clubbing as a sign of disease, and the phenomenon is therefore occasionally called "Hippocratic fingers"..... ** Lung cancer is the most common cause of clubbing. Clubbing often occurs in heart and lung diseases that reduce the amount of oxygen in the blood. ... Heart defects that are present at birth (congenital) Chronic lung infections that occur in people with bronchiectasis, cystic fibrosis, or lung abscess....... *** While the NAIL BITING and picking seems to be such a common problem, the psychological and medical research does not agree on the exact motivation for the action. However, it suggests that nail biting can be the result of STRESS, VARIOUS MEDICAL DISORDERS, LEARNED BEHAVIORS, OR JUST PLAIN HABIT....... *** SPLINTER HEMORRHAGES : They run in the direction of nail growth. They are named splinter hemorrhages because they look like a splinter under the fingernail. The hemorrhages may be caused by tiny clots that damage the small capillaries under the nails. Splinter hemorrhages can occur with infection of the heart valves (endocarditis)....... *** YELLOW TOENAILS in an infection by a fungus that attacks the nails..... or, in some cases, they may be a sign of skin cancer. The fungal infection is caused most often by dermatophytes, which eat keratin to grow....... One of the MOST COMMON CAUSES of YELLOW NAILS is a FUNGAL INFECTION. As the infection worsens, the nail bed may retract, and nails may thicken and crumble. In rare cases, yellow nails can indicate a more serious condition such as SEVERE THYROID DISEASE, LUNG DISEASE, DIABETES or PSORIASIS....... *** WHILE NAILS ( LEUKONYCHIA ) : CAUSES : Iron deficiency anemia. Cirrhosis of liver. Kidney disease. Heart failure. Diabetes. Problems with the digestion of proteins. An excessive loss of proteins in the intestines. zinc deficiency........etc....... *** RED NAILS :- CAUSES : LUPUS patients get quirky, angular blood vessels in their nail folds. PSORIASIS starts in the nails up to 10 percent of the time and CAUSES SPLITTING and PITTING of the nail bed. 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15 year old,non smoker,2 wks h/0 cough,3 days h/0 fever with thrombocytopenia,altered RFT and LFT, breathlessness + ,streaky hemoptysis +Dr. Divya Jayan4 Likes36 Answers
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Middle aged male pt came with the complaints of fever and cough with sputum...15 days.. X ray findings? differential diagnosis?Dr. Suresh Narayanan5 Likes23 Answers
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Dear Friends We often get cases of haemoptysis to manage. Let's have a detailed update…. HAEMOPTYSIS Differential Diagnosis of Hemoptysis PULMONARY PARENCHYMAL SOURCE.. Tuberculosis Pneumonia Lung abscess Lung contusion Mycetoma Idiopathic pulmonary hemosiderosis Wegener granulomatosis Lupus pneumonitis Goodpasture syndrome TRACHEO-BRONCHIAL SOURCE.. Bronchiectasis Neoplasm Bronchitis Broncholithiasis Airway trauma Foreign body PRIMARY VASCULAR SOURCE Arteriovenous malformation Pulmonary embolism Elevated pulmonary venous pressure Pulmonary artery rupture MISCELLANEOUS AND RARE CAUSES Systemic coagulopathy or thrombolytic agents Catamenial hemoptysis (pulmonary endometriosis) PSEUDO HAEMOPTYSIS Upper airway source(like nose) Gastrointestinal source(haematemesis) Serratia marcescens (gram-negative bacterium that produces a red pigment that may be mistaken for blood) Malingering HOW HISTORY SUGGESTS…. ETIOLOGY OF HAEMOPTYSIS… (1)h/o ANTICOAGULANT USE.. Coagulopathy (2)h/o COUGH… Bronchiectasis, COPD, foreign body, pneumonia, tuberculosis (3)h/o FEVER.. Tuberculosis, Bronchitis, lung abscess, neoplasm, pneumonia, pulmonary embolism, (4)h/oHEART DISEASE.. Congestive heart failure (5)h/o RECENT SURGERY OR IMMOBILIZATION… Pulmonary embolism (6)h/o SMOKING… Bronchitis, COPD, neoplasia (7)h/o SPUTUM PRODUCTION Bronchiectasis, COPD, pneumonia, tuberculosis (8)h/o TRAUMA Airway trauma, pulmonary embolism (9)h/o WEIGHT LOSS COPD, neoplasia, tuberculosis WORKUP AND MANAGEMENT Chest radiography.. Plain x-ray or CT thorax may provide clues about the etiology, as well as guide further resuscitation and evaluation. Treatment of the possible cause of haemoptysis should be initiated. Once the bleeding site has been determined, the patient should be placed in the lateral decubitus position with the affected lung down to prevent pooling of blood in the unaffected bronchial system. Rapid bleeding warrants immediate airway control with rigid bronchoscopy or endotracheal intubation Flexible bronchoscopy is less effective in maintaining a patent airway, but can provide useful diagnostic information. For stable patients with no identifiable cause detected.. chest CT angiography and/or bronchial artery arteriography with or without embolization should be performed. Thanks I hope this information on HAEMOPTYSIS will be HELPFUL to most of us Dr K N PoddarDr. K N Poddar27 Likes31 Answers
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Dyspnea It is normal with all of us when we exert excessively.. But Dyspnea that is greater than expected with the degree of exertion... is a symptom of disease. Most cases of dyspnea result from asthma, heart failure and myocardial ischemia, chronic obstructive pulmonary disease, interstitial lung disease, pneumonia, or psychogenic disorders.. Below mentioned are the pathological causes of Dyspnea by Organ System…. CARDIO-VASCULAR… Pulmonary edema Acute valvular disease Myocardial infarction Cardiac tamponade Heart failure Angina Constrictive pericarditis RESPIRATORY… Acute exacerbations or persistent chronic asthma Acute exacerbation or persistent chronic obstructive lung disease Pulmonary embolism Pneumothorax Pneumonia ARDS Anaphylaxis COPD Asthma Interstitial lung diseases Pulmonary hypertension Malignancy (tumor related obstructive lesions and lymphangitic spread) Pleural effusions Sleep apnea Foreign body aspiration GASTROINTESTINAL/HEPATIC Acute liver failure and its consequences Abdominal distention of various causes Ascites Portopulmonary hypertension Hepatopulmonary syndrome RENAL CAUSE Acute or chronic renal failure and its consequences HEMATOLOGICAL… Hemorrhage Anemia NEUROMUSCULAR High cervical cord lesions Trauma to phrenic nerves Central apneas Myasthenia gravis Myopathies Amyotrophic lateral sclerosis ENT cause Vocal Cord Dysfunction Laryngeo-tracheal obstruction PSYCHOGENIC BREATHLESSNESS I hope this list of causes will be HELPFUL to diagnose the aetiology of DYSPNEA…Dr. K N Poddar19 Likes21 Answers