Chest pain with cough

Chief Complaint A 62 y/o male presented with right chest pain & productive cough with yellowish sputum. She also had 10 kg weight loss in last few months. History He is a chronic smoker for the past 20 years and drinks alcohol occasionally. He is not on any medication. Vitals BP: 130/80 mm Hg, Resp rate: 30/min, HR: 110/min, Temp: 101 °F, oxygen saturation 80% on room air. Examination Physica examination was normal Heart exam shows tachycardia. Lung shows diminished breath sounds on the right side in the upper zone. Investigations Albumin-2.3, total protein-4.7, total bilirubin-normal, AST-50, ALT-20 and alkaline phosphatase 44. WBC: 11,500/mm3, lymphocytes 9%, neutrophils: 39% , monocytes: 20%, Hematocrit 35% Platelet count: 185,000/mm3 Sputum and blood cultures-negative. Sent for x-ray. Treatment What is your valuable opinion?

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? LRTI .. ? BRONCHITIS .. ? KOCH'S.. ILD .. NEED'S CLINICOPATHOLOGICAL EVALUATION WITH.. HEMOGRAM.. SPUTUM STUDY.. CXR .. HRCT THORAX.. ECG 2D ECHO STUDY..

Tnx Dr Ashok Leel sir
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Chronic bronchitis with emphysema. Under present circumstances covid 19 Infection must be ruled out and protocols must be followed.

Thanks Dr G Tripathy
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Chronic bronchitis with emphysema Antibiotics like Doxycycline100bd Foristal1bd Cough syrup containing bromhexine

Thanks Dr. Kute Ankush, Dr. Gyanendra Tripathi , Dr. Sachin Ambure , Dr. Ashok leel
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Drop in saturation and tachypnea indicate respiratory failure He needs oxygen support and occasionally may need ventilator support Adv Admission to intensive care unit Differential diagnosis Covid 19 Pneumonia Lung abscess Tuberculosis

Possibilities Pul Kochs with pleural effusion Lung carcinoma as chronic smoker COPD ? Chronic bronchitis with respiratory failure Covid 19 in present era

Oxygen support...or Life support..if required X-RAY chest HRCT THORAX 2D ECHO SPUTUM FOR AFB CBNAAT ESR RTPCR WITH ALL REQUIRED HEMATOLOGICAL INVESTIGATION TO CONCLUDE

Thanks Dr. Vipin Bihari Jain
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Clinically Fever+ Chest pain-? pleuritic-pleuricy ?Right upper zone fibrosis/collapse Adv- ESR,ABG,Sputum AFB, CXR,2D echo,Covid RTPCR,LDH, D-dimer HRCT thorax accordingly Provisional dx- ?PTB ? Infective exacerbation of COPD in ? respiratory failure ? Covid 19 infection ?CA lung

Adv cxray HRCT thorax ABG Echo CD

Xray chest

Chronic bronchitis ?mass lesion rt.upper lobe with sec bacterial infection . Chest xray/Ct chest

Thx.Dr.Vipin
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