This is a10 yr old male c his of fever and cough 8 days.his of swelling affecting left upper and lower limb associated c pain.o/ e res distress,decreased air entry on left side c e/0 painful pitting edema of Lt upper and lower limb.joint movement restricted. left normal.CBC polymorph I nuclear leucocytosis.urine normal,renal parameters normal. dd

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This 10th old male child with fever of 10days cough and resp dystress....suggests... severe pneumonia...With diminished breath sounds on left....suggests...left pneumonia with synonymous effusion. ...ie empyema. ...One more important subtle finding here is mild obliteration of umbilical pit due to encroach of its lips ...suggests abdominal wall oedema....meaning plasma leaks....ps study shows neutrophylic leukocytosis ...so this child has bacterial pneumonia with empyema with plasma leaks ie septic shock in leaky phase....He requires interventions accordingly in terms of pediatric septic shock pals algorithm and icd if needed.....now how to explain oedema of left upper and lower limbs.... careful observation reveals engorged veins over left clavicular region extending on to shoulder...but difficult to explain lower limb oedema....to accommodate oedema of both lower limbs as a second possibility filariasis in endemic areas to be considered.....third remote possibility of a malignancy needs to be entertained ....

Pleural effusion with arthritis ,JIA to b ruled out ,Tb to b addressed pleural effn with pauciarticular arthritis ,CBC ESR MT PL tapping n fluid analysis ,ANA DsDNA ,Gene xpert of fluid .

c 8 days fever? jia? tb.its acute
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child had e/0 arthritis major joint clinical ly,c pleuropneumonia,thought of atypical pneumonia mycoplasma. pt responded clinically.

This is a case if RD with sepsis, Pneumonitjs on left side, with left upper limb & lt lower limb Lymphangitis. Dr Brahmananda Pediatrician.

thrombophlebitis due to iv caths too needs to be entertained to explain oedema of upper and lower limbs....In picture lower limb oedema is not seen....covered by cloths it seems

Pneumonitis associated Meningitis and MODS Sepsis

may be pleural effusion,as h/o of fever n cough is their.If effusion present then do diagnostic tap

cause of swelling may be lymphangitis or as child seem to be septic also ruled out cellulitis

severe pneumonia with meningitis

Pluar effusion

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