An elderly man presents with cough and sob since 2 months.

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There is an area of hyperlucency in the lower left chest with surrounding dense area.. The leison seem to be in the lungs as diaphragm can be seen separate from the shadow below... Possibilities are. Ruptured hydatid cyst as an area of break is visible at the upper part of the cyst.. Other possibility are loculated empyema or effusion.... A cavitatory lesion.. CECT THORAX is needed to delineate the lesion .. Serological test can be done to confirm hydatid cyst

If diaphragm is visible it is not like to be diaphragmatic pathology or sub diaphragmatic pathology.. D/d are.... Ruptured any cyst .. May be hydatid.. Encysted effusion.. Sub pulmomonic effusion with Incomplete drainage.. Cavitatory lesion and lastly haitus hernia

Usg guided aspiration can be done If hydatid cyst is excluded . Send the fluid for analysis.. Including afb smear and bactec culture.. Malignant cells.. It will be helpful to diagnose the case

Good spot case dr vamsi.. A Gas shadow below is mimicking the gastric bubble.. So difficult to think of phrenic nerve paralysis.

The diaphragm is clearly outlined... hence it's away from the round lucency seen. It's above the level of the right hemidiaphragm meaning it's pulled up.. or may be pushed up. The round lucency seen below the left hemidiaphragm is usually the fundus.

Could be a phrenic nerve palsy or a gastrointestinal pathology. This patient had past history of abdominal surgery. Twice. So... ??

When the diaphragm is seen clearly why do you think it belongs to the Lung,I mean in the Lung Dr K N Poddar.

Hiatus hernia with pleural effusion left with pulmonary koch's, advised surgery & AKT.

Left sided pleural effusion with a thick walked cavity left lower lobe

Depending on the findings in the cxr... what are the pissible DDS.

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Diseases Related to Discussion

Empyema
Hernia
Hiatus Hernia