A 38 year male was admitted to ICU with complains of fever (on and off) since one month, dry cough since 3 days and irritable and agitated behaviour since 2 days. Vitals were stable. SpO2 of 96% on O2 through face mask @ 4 lits/min. Patient is a known alcoholic and not consumed alcohol for last 5 days or so. Kindly interpret CXR and discuss differential diagnosis and further management.



Massive pl effusion rt with pishing effect Irritability and agitation as pt has not alcohol for five days (withdrawal effect) PD tubercular pl effusion rt Adv asp and cbnaat of pl fluid Cyto and bio of fluid

Massive right pleural effusion. Trachea slightly pushed to left.Diagnostic tap should be done .And till then empirical antibiotics cover to be given.Pssibility of TBM should be considered along with withdrawal symptoms.Other possibilities should be acute pancreatitis and ARDS also.Should be kept NBM, o2, and input/ output to be maintained.Get LFT, RFT, electrolytes and CT brain.

Ans:-Xray chest AP view shows Rt sided massive pleural effusion and tracheal shift towards left.D/D:-1:-tubercular2:-consolidation rt lung-Pyogenic effusion.3-malignant pleural effusion but usually it is bilateral so most likely effusion is tubercular.To find aetiological diagnosis pleural fluid aspiration and cytology is done and treated accordingly.

Massive rt pleural effusion with tracheal shift to left Aspiration diag and therapeutic should be done inj antibiotics Pl fld routine ADA GS/ CS / ZN stain / cbNAAT /cytology Usg chest &abdomen Cbc .RFT .LFT Bloog sugar Dd tubercular / pancreatitis/aspiration CT chest and brain Cns symptos could be to TBME /ALC withdrawl/

Right pleural effusion with mediastinal shift, thoracentesis (diagnostic + therapeutic), icd if empyema, other routine inv with LFT. Altered behaviour could be withdrawal, look for other focal neurological signs. Till then treat symptomatically. Do post a follow up with reports

Massive right sided pleural effusion. Irritability and agitation are part of alcohol withdrawal .Pleural tap for cytology, biochemistry and CB NAAT to be done. Most likely tubercular.

Massive right sided pleural effusion, causing trachea to shift to right, as patient is a known alcoholic, rule out pancreatitis

Rt sided massive pleural effusion do pleural tapping send pleural fluid for routine and microscopyy, ADA, cytology, culture

RT side effusion Diagnostic tapping...rule of maliganacy or infection AL withdrawal syndrome.. Inj loraze 2 mg IV SOS ..

Diagnostic and therapeutic aspiration should be done CBNAAT for pleural fluid is not indicated

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