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..
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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
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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
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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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