Interpret x-ray

Chief Complaint A 61 y/o female with a PMH of chronic hepatitis C infection & htn came with generalized weakness, fevers, tirdness and patient is not eating anything. History On examination patient was confused but conscious. He has left lateral gaze palsy, Investigations Serum sodium level 126 mmol/L (normal 135-150 mmol/L) and a platelet count: 88,000/µL (normal 150,000-400,000/ µL). Creatinine level raied to 1.13 mg/dL. Diagnosis Chest x-ray is posted below. Please advise diagnosis and treatment

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Good case for clinical interaction. On the first look it seems to be pyrexia with thrombocytopenia with encephalopathy. It could be viral infection dengue has to be ruled out with elisa antibody test. Pt has hyponatremia that could be the reason for drowsiness &neuro deficit.he has 6 th nerve palsy on Lt side.any other localizing neurological deficit like mortar deficit.extensor plantar.mri brain with angio is needed x ray reveals consolidation Lt base.it also has to be worked out. Pl rule out any evidence of tuberculosis. After getting MRI report csf analysis can be planned. T/ t wise first correction of hyponatremia. Iv fluids. Pl have a check on platelet count daily twice a day if necessary pl go for pt/ inr &a PTT

CXR.. BL.. HAZINESS.. NEED'S.. HRCT.. RT..PCR..COVID-19..

Tnx Dr Rajendra Rai
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Suggests chronic bronchitis Rule out COVID-19

Thanks Nihar Ranjan mohanty,Dr. Dinesh Gupta Dr. Ashok leel
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X ray chest shows haziness in left lower zone which may indicate COVID 19 infection, pneumonia Adv HRCT chest, RT PCR for COVID 19 In addition this patient has multiple problems 1) Chronic hepatitis C - now the term 'chronic' in chronic hepatitis C has become obsolete!!! In the past hepatis C was treated with Ribavarin and interferon which has very low cure rate is 20 - 30 % But now with advent of Sofosbuvir based antiviral treatment there is astonishing 96 - 99% cure rate with 3 month of therapy Now Hepatitis C is completely curable with very safe 3 months regimen, therefore it is no longer a chronic illness, but it should come as past history of hepatitis C now cured!!! 2) This patient has thrombocytopenia which need complete work up Dengue, malaria, Leptospirosis etc 3) This patient has lateral gaze palsy - which needs evaluation by CT brain

Dr Kumar Note left basal opacification Consider it pneumonia Hyponatremia was associated with higher levels of inflammatory markers, suggesting that hyponatremia is more common in patients with more severe pneumonia. Hyponatremia the hyponatremia may have been due to the syndrome of inappropriate antidiuretic hormone (SIADH) Thrombocytopenia Thrombocytopenia is also a recognized marker of poor outcomes in patients with pneumonia due to the association of low platelet counts with disseminated intravascular coagulation and severe sepsis. Kidneys are also being affected

Allready well explained by all seniors Drs. , COPD, EMPHYSEMA, LRTI, CHRONIC HCV, PNEUMONITIS, DUE TO COVID -19 , DO RTPCR, LOW SODIUM DEVELOPS CONFUSION, HTN DUE TO PORTAL HTN, CT HEAD, USG W/A, RTPCR, SERUM ADA, HRCT CHEST, 2D ECHO, ECG, RT PCR

Thanx@dr.nihar Ranjan Mohanty ji
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Rt dome is pulled up Lt basal opacity is likely pneumonitis Pt is in hyponatremia and thrombocytopenia Mental confusion Viral pneumonitis with ?encephalitis Think of covid

Thanx dr Rajendra Rai
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Ruleout Corona virus infection.... Hyponatremia management, fluids and clarithromycin based treatment. BIPAP therapy.... vitamin supplement. DVT and PE prophylaxis....

Chest x-ray Hyperinflated lung fields, cardiovascular markings prominent bilateral,basal hazyness noted bilateral,apical hazyness bilateral also noticed.

COVID 19 virus pneumonia Under present circumstances covid virus Infection is very common so rule out first. Protocols must be followed.

Thanks Dr Vipin Bihari Jain
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