Female patient at 50s presented with fever 39 c , cough , wheezy chest ,dyspnea



Left lower lobe consolidation wirh mild pleural effusion. Mild cardiomegaly with Prominent broncho vascular bilaterally.

Lower respiratory infection? Lvh? Left plural effusion needs Ecg with Bnp test

Left lower lobe consolidation collapse needs hospitalisation further management with antibiotics.

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Xray shows left lower zone heterogeneous opacities with cp angle obliterated with bilateral cardiac enlargement specially more on left side . With all Pt having fever all these suggests that it's a case of "k chest with left pleural effusion with copd elements cousing secondary cardiac overload leads to cardiomegaly " in nutshell it's a case of "kchest copd corpulmonale"

A further evaluation is needed with blood and sputum examination, a ecg also needed ,u can start with a broad spectrum antibiotic,evaluate after 7 days

Consolidation lt lower lung zone.....prominent bronchovascular markings bilaterally

Pl treat empirical with inhalation therapy, sputum examination with blood investigations , lt pl effusion with lt lz infiltrate with bronchiectatic changes

Please send for CBC,sputum gram stain,sputum AFB, sputum culture , Blood culture, HRCT chest, and start empirical antibiotics IV Ceftriaxone and Azithromycin,3% Saline nebulization and other supportive treatment.

After confirmation of infection through blood reports, first we should treat with antibiotics accordingly and to strengthen the Respiratory system, I will suggest timely tested and experienced potent Ayurveda Medicines without side effects and rather will strengthen allied systems. Prof.Dr.Satendra Kumar Goyal -M.D.Ayurveda

suspect for tuberculosis? do Sputum for AFB and Igg or Iggm for tuberculosis

rarely think of Koch's in lower lobes alone

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Left pleural effusion with Cardiomegaly with bilateral infiltrates in the lower lung fields

Looks like pneumonia

I agree with Dr Nilesh Pawar. If this type of symptoms are present with wheez and either not responding to usual bronchodilators or again going to spasm especially when presenting with fever then first we should think of LRTI. If community acquired then Penicillins with beta la tar and macrolides and if it is hospital acquired then start with broad spectrum like 4th generation cephalosporins or preferably carbapenams. Definitely all blood investigations and if possible sputum if it is productive cough and BNP cardiac assessment can also be done if history suggests so. This I tried my best to contribute otherwise work up can be extensive depending upon condition. Thanks

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