diagnosis.....???...age-25yr male....4 days history of chest pain and generalised weakness....patient is conscious... bp 90/60mmhg..... spo2...80%..... PR 110 M.P. para test-PF weakly positive in mp antigen test widal- O 1:80 I 1:40 S.bil T O.79 D O.18 I. O.61 S.creatinin 1.30 hb 9.9 tlc 3800 poly 64 lymph 35 eocinophils 01 monocyte 0 baso 0 RBC 3.94 platelet 0.34 lac/cumm pcv 30.7 mcv 77.9 mch 25.1 mchc 32..... ESR 20 .. .. auscultation- both chest side...equal...no any added sound present percussion-as normal.....




History of chest pain with Hypotension spO2 - 80% Tachycardia Leukopenia Consolidation involving whole of right lung Pointing towards LRTI possibly Pneumonitis.. But rule out TB and send procal.... The pt can deteriorate , so start with broad spectrum antibiotics and supportive care...

Working diagnosis: Right Pneumonia with sepsis Suggest: Fluid challenge If does not respond to fluids initiate vasopressor support Consider NIV support Send chest secretions,blood and urine for c/s Start Broad spectrum antibiotic as per hospital antibiotic policy Add Nebulisations Supportive management Monitor hrly BP and U/O Regular monitoring of platelets Send samples for: PCT LFT Dengue NS1 Though the possibility is less but send throat swab for H1N1 and Koch’s Routine labs.

X-ray - rt side massive consolidation with shift of trechea to rt side Pltb with pneumonitis Needs further investigation till Higher antibiotic Cbc and esr Ecg sinus tachycardia Treat Malaria at the same time

Jayegi opacity right lung. Tachycardia and leucopenia Broad spectrum antibiotics and supportive care Needs further investigations,evaluation and Constant monitoring.

Thanks Dr Bara.

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Hatero opacity right lung. Trachea and mediastinum shifted to right. PTB

Opacities RT lung Shifting of trachea & mediastinum to right ? PTB

Thanks Dr R L Bara

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Tuberculosis Rt lung Rx Antitubercular drugs for 6mth as per schedule fist 2mths intensive phase & then Continuation phase for next 4mth & Symptomatic treatment as 5

Low spo2 shifting of trachea towards Rt consolidated lung indicating initial stage of fibrosis causing atelectasis.Need spiral ct thorax.

Consolidation Lung.? Rt. Sided pneumonia. Developing septicaemia with MOF. S.creatinine elevated.Low TLC,platelet count 34000/cmm


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