60 yrs old male pt admitted with h/o breathlessness. ..One week . chronic smoker. X ray chest opinion and treatment . plz share your views. ..

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Dear Dr Suresh.. There is a giant bulla on the right upper zone.. Development of this bulla compressing the other part of the right lung may be reason for breathlessness... D/d is encysted pneumothorax.. But Radiologically looks like bulla then pneumothorax.. HRCT will give you the final answer... Bullectomy for bulla is needed... With other supportive measures

excellent answer sir. ..Thank you so much sir. ..
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Cxr consistent with copd, prominence of bronchovascular markings more on rt side, may having pulmonary venous hypertension, incipient heart failure?, need 2d echo.

Thanks Dr. debasish sir..
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wonderful explanation sir..Thank you so much. .bulging fissure sign usually seen in UL CONSOLIDATION due to klebsiella pneumonia. .especially in males..old age..With alcohol history. . In this x ray bulging fissure is due large bullae. .not due to consolidation. .. I have seen 3 cases of klebsiella pneumonia. .and bulging fissure sign. .but this bulging fissure due to large bullae I have not seen previously. .For rarity I have posted this x ray. ..I'll update once I got the CT film ...Thank you for all the participants. ..

Sir wonderful, thank you for teaching us.
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Bulging fissure sign is seen usually when klebsiella pneumonae affects the right upper lobe.. Expansion of the pneumonic consolidation causes bulging of the horizontal fissure with a convexity downward.. With the early use of antibiotics this sign is rarely visible now a days...

Thank you so much sir
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This is plain chest X-ray PA view showing : Underexposed film, Trachea is central, soft tissue shadow normal, Posterior ribs are placed parallel to each other, Bilateral costophrenic and cardiophrenic angles are free, Cardiac silhouette looks normal except aortic knuckle is prominent, Right lung field : there is a big radiolucent bulla in RUZ with prominence of right horizontal fissure. Right peri hilar congestion. Left lung field appears normal except mild peri hilar congestion. Both domes of diaphragm appear pushed down. Impression : Emphysematous lung with right upper zone giant bulla.

Bullae are common among smokers and also seen in tall stature individuals like marfan syndrome, people with marfanoid features.
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DEFINITELY A GIANT BULLA SEEN IN RT UPPER & MIDDLE ZONE COMPRESSING THE REST OF THE RT LUNG LEADING TO BREATHLESSNESS ADV HRCT,PFT STEROIDS OXYGEN BRONCHODILATORS ANTIBIOTICS NEBULISATION

Thank you so much for ur expert opinion sir..
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there r two bullas on RUZ & one on LUZ. lungs are hyperinflated & bronchovascular markings prominent on right.s/o COPD. do ct chest for further evaluation.management will be bullectomy & rest conservative for cold viz bronchodilayors, nebulisation, oxygen if required.

Thanks sir. .We will confirm our findings with ct report ..I'll update sir..
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Hypodense lesion in rt lower lobe Hrct expiratory plates Cbc ESR Mt Pneumonitis r/0 sarscov2 Fungal ball Tuberculous Sarcoidosis Large tumour Broncoscopic biopsy HP

adv pft pre and post bronchodilator to confirm irreversible OAD. ECG n 2decho for PASP to rule out cor pulmonale. Treatment inhaled bronchodilators and inhaled steroids with Inj .Derriphylline IV tds n n- acetylcysteine nebulization tds, IV antibiotics if any infective exacerbation. chest physiotherapy after exacerbation period. patient may be taught pursed lip breathing however during exacerbation.

RMZ RUZ hyperlucent s/o pneumothorax secondary spontaneous pneumothorax

Thanks sir
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