Productive cough & Leg edema

Chief Complaint A 66 year old male presents with cough with greyish brown sputum, dyspnoea & edema of legs. History She is a smoker with 15 cigerrates/day and no alcohol use. VItals BP: 130/80 mmhg, Resp rate: 22/min. Heart rate: 82 beats/min, Pulse oximetry: 92% with nasal canula. Examination Patient is thin build and looks fine but edema of legs is present. Lung examination shows diminished breath sounds. Investigations Tuberculin skin test negative. Lab investigations normal except for creatinine which is 2.0 mg/dL. Chest x-ray shows cardiomegaly, pleural effusion on left side & calcifications. Treatment What could be the cause for calcifications and advise treatment.




Needs further investigation and evaluation to conclude. * TUBERCULOSIS ** Malignancy Under present circumstances covid 19 Infection must be followed and protocols must be followed.

Thanks Dr Sandeep Ghodekar

Do USG c FNA Rule Out Respiratory Pathology Tb? Malignancy? Pneumonia? 2D ECHO for Cardiac Pathology RHD? Post-MI?

CCF with CRF with hypoxia Do hrct RT PCR pft 2 decho CBC CRP ESR ldh ferritin LDH Ddimer il6 Ecg Opinion of neurologist & chest physician

Possibly COPD exacerbation with superadded infections. Evaluate for PAH USG abdomen to rule out medical renal disease. Could be pleural thickening or plaque. Diagnostic and therapeutic pleurocentesis.

Calcifications,on left side where there is pleural effusion could be due to 1.Tuberculosis 2.Malignancy 3.Pulmonary fungal infection 4 As creatinine is 2 .0 mg /dL - sometimes Calcification can be seen in chronic renal insufficiency In this case most likely cause is PULMONARY tuberculosis or malignant disease Further evaluation is indicated by 1.Pleural fluid aspiration and testing for AFB , Genexpert testing , cytology for malignant cells , ADA levels and biochemistry 2.Sputum for AFB 3.HRCT chest 4.2D - Echocardiography. 5.Ultrasonography abdomen for kidneys 6CBC , LFT As pedal oedema can be due to CCF, CKD , Anaemia and hypoproteinemia appropriate can only be started after the investigations are complete

Respiratory: Do HRCT-thorax+USG guided diagnostic/therpeutic thoracocentesis+ sputum AFB/CS Start emperical antibiotic ( Azithro+ Ceftriaxone) / oral moxclav 625 TDS Low flow humidified O2 + Nebulize Cardio:BL pitting pedal edema / cardiomegaly-> do a 2D echo with colour Doppler ..look for asso symp- palpitation/dyspnea/orthopnea/PND/Murmurs Nephro: acc to CKD-EPI score it's stage 3B CKD with 33 eGFR.. Check K level.. do an USGKUB+REMECS

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