Pt is a female aged 85yrs came with Shortness of breath since 1 hr kco of COPD DM HTN Hypothyroidism old case of CVA 3yrs back had a history of slip and fall 4 months back.had conservative management Interpret X Ray findings and Management 2nd X-RAY of rt knee joint is of recent date.

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Cxr shows fibrocavitatory lesion.. May be ILD.. CT Chest will confirm it..acute SOB may be due to PE/DVT? There is rt sided IT #femur with callous formation. Are there any signs of DVT as the patient may be bedridden for a long time... Urgent 2d echo, d-dimer, CT Chest are the required tests..

I agree
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Cardiomegaly is there which is natural out come of copd htn and hypothyroidism Now pt is in ICU due to acute excer of already existing pathos Trtmt is symptomatic. As we can only manage the pt but can not cure s So Go symptomatically

Looks like fat embolism Cardiomegaly present

Copd, hypothyroidism bad combination Cxr flat diaphram, rib crowding on rt side, cardiomegaly,looking like pt is aspirating (aspiration pneumonia) shaft femur #,better start augmentin n clinda,accept saturation above 84,sos niv, neb ipratropum levosalbutamol,methylpred 100 stat Cbc, SE, RFT sputum c/s,Urine routine c/s, bsl of high urine ketone

This pt is hvng fracture long bones and in a bed ridden state. Sudden onset breathlessness, raises the possibility of pulmonary embolism. Cxr is s/o cardiomegaly with conspicuous descending pulmonary artery. Could be pulmonary hypertension secondary to c.o.p.d. we shd get 2 d echo, look for pulmonary artery pressures, RA/ RV dilatation, ejection fraction and cor pulmonale. D dimer , ecg for sinus tachycardia, s1q3t3 and rt. Axis deviation or rbbb shd be looked for. Any evidence of DVT? Next is routine tests with pt/INR and abg. Auscultate and see fr crepts, rhonchii, spasm. If pulmonary embolism is a possibility as per these investigations, cn get CT pulmonary angio done. Treat with enoxaparin 60 mg twice a day. Otherwise, at least 40 mg once a day prophylactic dose shd be added. Treat c.o.p.d with bronchodilators, nebulization etc.

#neck femur(r),suggested conservative, symptomatic treatment taking into consideration age n comrbities

ABG maybe co2 narcosis than traction orthopedic opinion symptomatic treatment

A pt. At this age shows cardiomegaly on x- ray and needs to be examined at close quarters And needs investigations to reach A conclusive diagnosis, may be suffering from multiple pathology.

Cardiomegaly in CXR CTPA to rule out PE as cause for acute breathlessness

I agree with Dr L Kumar

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