c/o dry cough on n off wich relieves on medication since 2 yrs.sputum AFB negative.dx n D/Ds

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D/D of chronic cough.. Dailated cardiomyopathy as heart shadow looks enlarged.. Other cardiac diseases... Needs echocardiogram Other causes like G e reflux Cough variant asthma Post nasal drip are other common possibility List Of uncommon and rare cause is long........

sir is it nt expiratory film ? ur expert opinion regarding that..

Raised left diaphragm is also to be evaluated... Normal variant or left lower lobar segmental collapse...

Any history of regular medicine for hypertension?

no sir.no such history

Chronic cardiac disease with upwards of left side diaphragm gastric reflux with oesophagus allergic bronchial asthma.

Expiratory cxr repeat xr than can be commented.

For proper inspiratory film 9 ribs should be countable posteriorly.. So not truly inspiratory.. But one thing for sure that left diaphragm is raised.. Cardiac size should not be evaluated in a expiratory film.. As it gives an impression of enlightenment.. So i commented probably... X-ray chest is not showing any parenchymal lesion in the chest.. So with 2 year history any structural defect in the lung as a cause of cough is almost ruled out

Enlargement not enlightenment

left dome of diaphragm elevated... if dry cough rule out Gerd and achalasia cardia.... treat with PPI and proline tics also u could try montelukast 10mg bd... Plz get ct chest for completion

PPI and prokinetics

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Pericardial effusion, rule out koch's.

Full inspiratory film 10 th rib post sir and left Lat chest for further eval

Than cardiac eval for biventricular configuration,

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