40Y male k/c/o DMtype2 since 2years on OHA presented with cough with expectoration and dysphagia since 20days. He also c/o SOB and tiredness on exertion. H/o recent Right lower lobe pneumonia is on Rx Moxikind and now it is in resolving phase. Sputum AFB neg. Not a known Hypertensive. Non-Alcoholic/Non-smoker. O/e No pallor/cyanosis/pedal edema. PR 103/min, BP 110/70, RS: B/l basal crepts+ Spo2 95% room air. RBS 212, HbA1c 7.6%. USG abdomen: Grade2 fatty liver, Splenomegaly, Cystitis, Gross prostatomegaly. ECG and CXR attached. Kindly discuss findings and management.

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ECG is suggestive of 1. LVH and lv strain pattern. also there is T wave flattening in inferior leads, possibly rv strain 2. p pulmonale Is there any history of hypertension and any drug intake? Patient may have underlying cor pulmonale also. Current history and examination findings are suggestive of urosepsis with pneumonia. CXR is suggestive of hilar lymphadenopathy and mediastinal widening. also, I can see some air bronchograms in right lung suggestive of pneumonia. Patient needs ICU admission. and management accordingly. Please get a Cect chest and 2D echo done for the patient along with routine blood counts and metabolic panel. Send cultures of blood, urine and sputum. I think this may be enough. please tell if I need to tell management in detail.
shortness of breath with bilateral basal crests, also patient has tachycardia with heart rate of 103 per minute, so there is strong possibility acute left ventricular failure. treat wuthering diuretics and broad spectrum antibiotics. tight glycaemic control should be done with fractional doses of insulin, do get culture of urine to find out cause of cystitis, chest x ray shows air bronchogram on right side with resolving pneumonitis, ecg is showing LVH with strain pattern. 2d echo should be done in this case, also get KFT report.
Unusual to have gross prostatomegaly at 40 years of age. Evaluate for same There is LV type cardiomegaly on xray with ECG supporting LVH. Patient appears to be in LV failure. Prominent inferior pulmonary vessels in LVF may appear like right LL pneumonia. Fatty liver is due to NASH in diabetes. Splenomegaly is by chance finding or due to chronic liver disease (NASH). Fever, blood counts, LFT, RFT are important investigation to be taken into consideration.
This is a case of cor pulmonalae with non- responsiveness to treatment due to DM ( uncontrolled ) . ---- Adv :-- 1) HRCT of Chest 2) Sputum for detailed exam. For 2 con. Days 3) Rpt. Bl. R/E , Hb%,HbA1C level est. 4) Serum C/S >>>>> following the invest. Results. Selection of Chemotheraputics , bronchodilators. + Antidiebetic regime with Recent gen long acting Insulin . etc.
Bilateral basal crepitation with shortness of breath on exertion in the background of DM, kindly rule out LVF leading to pulmonary edema, do 2D Echocardioraphy and BNP level, and give diuretics , treat pneumonia properly with appropriate antibiotics otherwise your patient will land up in DKA.
sir ecg shows two thing 1 prolong p-r interval and 2 tall p wave so it may b cor-p or av block and from chest lead we can see rvh and x ray also show sign of dialatation so we go through echo for further diagnosis and conformation
2d echo..as ecg shows proloned pr interval suggestive of 1st degree heart block. urine culture for cystitis..psa for gross proststomegaly..cbc to comment on clinical resolution of septic pneumonitis
most probably he has cardiac failure along with pneumonia.sir please do an echo and start diuretics along with antibiotics, strict glycemic control check for any cardiac event in past.
I would definitely recommend an ECHO to look for LV dysfunction and of course workup to rule out infection
patient must go for ECHO as there is LVH.patient might be having DCM as past history is also important
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