around 35 yrs old male pt admitted with h/o. New onset of seizures and status epilepticus.. 1. what are the clinical findings? 2 .x ray findings. 3.ecg findings. 4. CT BRAIN ..plain and contrast findings. . 5. With correlation of all these findings what will b the most suitable final diagnosis? plz share ur views. ..Thanks in advance. ..



There is cyanosis ,, muddy conjunctiva Clubbing Prominent pulmonary artery,, emphysematous changes,, patchy opacity in left upper lobe Right heart enlargement,, prominent p waves,,rt axis deviation Ring enhancing lesion in left frontoparietal cortex Looks like a brain abscess Congenital heart disease ,, looking at the age of the patient ASD with eisenmengers syndrome

Very nice approach sir. .Thanks a lot sir.

imuddy conjunctiva .. may b due to polycythemia pandigital clubbing .. and boot shaped heart.. ecg with rvh and strain .. ct suggestive of enchancing lesion may b abscess

may be tof with complicated with brain abscess

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Sclera is muddy, can't zoom the picture, there may sub conjunctival hemorrhage, grade four clubbing, chest X-ray is underexposed n shows prominent hilum, ct brain shows ring enhancing lesion with perilesional edema. Ecg lead placement is wrong for sure. U can see avr is positive. History and hemodynamic parameters of patient will be helpful to give a probable diagnosis Brain abscess- patient will be toxic with high grade fever Tuberculoma NCC

Thank you so much sir

Clinical H - Young adult presented with Status epileptic seizures Exam- Digital CLUBBING CXR- RV type apex, ?RAe EG - HR N, P pulmonale, RA deviation, Changing QRS amplitudes in rhythm strip, V1-r/s >1with t!, V2- sudden change to qs pattern, V6- No Q wave. CT Brain SOL in RT parietal lobe - hypodense with ring edema. Impression: young adult with adult CHD probably VSD eisenmenger or TOF with brain abscess and status epilepticus

Thanks a lot sir. .SOL in left side sir

clubbing,RVH,NSR RAD RBBB persistent s in v56 s/o VSD ct septic embolism with abscess ??aspergilosis possibility of infective endocarditis

Thank you sir

This may be a case of Congenital heart disease with left temporal abscess as a complication

Thanks sir

D/d brain abscess Tuberculoma Glioma Tt. Craniotomy and removal of tumour Histopathology

Thanks sir

Thanx Dr.Suresh for posting a very interesting case. 1) Clinically, Their is plethoric face with congested eyes and With CENTRAL CYANOSIS Digital CLUBBING of grade 3 2)CXR s/o Cardiomegaly with RV Apex type (Acute angle), with prominent Arteries with B/L Pulmonary Oligemia (upper zones) 3)ECG findings s/o Sinus tachycardia, Extreme Right axis/Right superior axis (axis pointing above +180) P pulmonale with clock wise rotation RVH with Strain pattern overall findings s/o Right heart dominance 4)ct brain s/o ?Ring enhanced lesion with MCA Infarcted territory with peri lesional edema in Left patieto temporal region 5) It must be the case of Adult male with ASD (Septum Secundum as their was Rt ward axis) with Eisenmengerisation with PARADOXICAL EMBOLISATION PDA with Eisenmengerisation with PARADOXICAL EMBOLISATION Thanx once again for a nice case scenario.

It's NOT VSD as their is no Features s/o Bi Ventricular enlargement on ECG... Thoroughly Clinical Examination and 2D echo will help to clinch the diagnosis. Their was No h/o fever as per described by Dr.Suresh apart from, Infective Endocarditis and Brain Abscess can be ruled out.

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Medical condition be what it may, the brain lesion is most likely to be an abscess or ??? metastasis. Fever is not necessary in brain abscesses. Young patient with features of lung and heart involvement of long duration goes more in favour of abscess than metastasis

why not it's infarct with Embolisation?

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Ictrus..clubbing.. t inversion inf leads..cystic lesion in temporal lobe..Likely Hydatid cyst..Bilat hilar enlarged l.nodes..

Thanks sir. .no icterus sir. .
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