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



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

Lower left zone consolidation. Duration? Cbc Esr Dm? If All r in normal range may b ch.asthamatic bronchitis

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

minimal left pleural effusion with prominent bronco vascular markings.Looks like a case of bronchial asthma exacerbation. Needs pleura fluid analysis may be just transudate due to infection.Slight RV cardiomegaly is also there suggesting cor pulmonale due to chonicity of the condition. Treat her with I. v. antibiotics, perenteral and local bronchodilators,external oxygen if saturation is compromised.

I agree there is rvh corpulmonale emphysema right compensatory left basal pneumonia.copd with emphysema

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LRtI -left pleural effusion with cardiomegaly

Blunting of cp angles L>R Prominent BVM. Adv Empirical Abx If productive cough then mucolytics. Can add nebulizer. Anti pyretics for fever management. If not responding then sputum C/S Blood C/S

Agreed wid Dr vijay gadhvi


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

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

Pleural effusion may be Koch's with cardiomegaly Sputum for AFB CT chest Plural tap and fluid examination

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