What is your diagnosis?

Clinical case Chief Complaints A 67 yrs elderly retired secretary presented with high grade fever, severe cough and breathlessness for 3 days. On query it was found that he has been suffering from long standing difficulty in deglutition for solid and liquid. He was also suffering from recurrent pneumonia History Pt non hypertensive Diabetic well controlled on OHA Vitals Pulse 120 regular BP 130/80 Rr 30/min Temp 39.8 Physical Examination Pt looks distressed due to SOB Investigations Hb 12.2 wbc 18000 poly 91% lympho 9% RBS 9.2 mmol/l ( normal less than 7.8) Chest xray homogenous opacity in right mid zone Diagnosis What is your diagnosis? Management Discuss drs

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Tnx Dr Anil Gangani
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Diabetic pt with uncontrolled diabetes as RBS is 9.2 mmol Xray chest presents homogeneous opacity in rt mid zone H/o recurrent pneumonitis with tlc 18000 needs to be evaluated adv hrct and BAL Send aspirate for pcr H/o long standing dysphagia Adv endoscopy to r/o any oesophageal pathology like malignancy as it can be secondaries from lungs or visa versa So far treatment is concerned preliminary you can put him on I v fluids Inj piperacillin+inj tazobactum Inj Ceftriaxozone Inj dexamethasone Inj deriphyllin Inj lasix Inj paracetamol Control diabetes with insulin and OHA Further treatment is to be modified after detail investigations

Thanx dr Anil Gangani
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Pneumonitis ?? Malignancy 1 ) primary 2) secondary Difficulty in deglutition Achalasia cardia Malignancy of oesophagus Ad Endoscopy of oesophagus if growth then biopsy for HPE D/D of lung pathology Ad CT guided bronchoscopy HRCT thorax For diagnosis and treatment

He seems to have aspiration pneumonia presently, and possibly recurrent laryngeal nerve palsy due to diabetes as underlying cause for recurrent similar episodes enlarged LA likely to be the cause for nerve palsy

ADV8SABLE 1 .... POSSIBLY PNEUMONITIS. NEEDS C T. SCAN... CHEST. AND. ABDOMEN 2. ... POSSIBLY.. * ACHALASIA CARDIA... * NEEDS ENDOSCOPY. FOR. OESOPHAGUS....

Plate of xray chest History with leucocytosis Favour rt midzone pneumonitis Check hb1ac fbs ppbs Oesophagitis Gi scopy Hrct RT pcr Oesophagitis with pneumonitis with sarscov2

Difficulty in swallowing could be due to C A. oesophagus with aspiration pneumonitis. U G I Scopy and Biopsy Other wise massive hiatus hernia with reflux oesophagus with aspiration pneumonitis. CT Chest will tell the pneumonitis stage and also confirm C A Oesophagus. With or with out mediastinal nodes.

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Uncontrolled DM2 with pneumonitis Control sugar with insulin Piperacillin tazobactum tds Amikacin 500 bd Nebulization LABA LAMA High flow oxygen

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