1 Vaishnavi harinarthini

 51 year old male patient who is resident of chityal ,and works in a transportation company came to the hospital with complaints of 

1- Fever since 10 days

2- Cough since 10 days 

3-shortness of breath since 6 days 


History of presenting illness : 

Patient is apparently asymptomatic 10 days back then he developed.


Fever since 10 days which is high grade , with chills and rigors , intermittent ,relieving with medication.

Associated with cough and shortness of breath.


Cough since 10 days which is productive ,mucoid in consistency,whitish ,scanty amount ,more during night times and on supine position ,non foulsmelling ,non bloodstained .

Right sided chest pain - diffuse , intermittent ,dragging type , aggravated on cough ,non radiating ,not associated with sweating , palpitations.


Shortness of breath since 6 days , insidious onset , gradually progresive ,of grade 3 - (MMRC scale ),not associated with wheeze ,no orthopnea ,no Paroxysmal nocturnal dyspnea, no pedal edema .


 History of pain abdomen or abdominal distension.

No history of , vomiting ,loose stools .

No history of burning micturition.

Past history : 

Patient gives history jaundice 15 days back that resolved in a week .

No history of Diabetes , Hypertension , Tuberculosis ,Bronchial asthma ,COPD , coronary artery disease , Cerebrovascular accident ,thyroid disease.


Family history : 

No history of Tuberculosis or similar illness in the family 


Personal history : 

Patient is a chronic smoker - smokes 5 cigarettes per day from past 25 years .

He is a Chronic alcoholic - cosumes 300 ml whisky per day ,but stopped since 3 months.

No bowel and bladder disturbances


Summary : 

51 year old male patient with fever ,cough , shortness of breath possible differentials 

1- Pneumonia 

2- Pleural effusion 

GENERAL EXAMINATION : 

Patient is moderately built and nourished.

He is conscious, cooperative,comfortable.

No signs of pallor ,cyanosis ,icterus ,koilonychia , lymphadenopathy ,edema .

Vitals : 

Patient is afebrile .

Pulse - 86 beats / min ,normal voulme ,regular rhythm,normal character ,no radiofemoral delay,radioradial delay.

BP - 110/70 mmhg ,measured in supine position in both arms .

Respiratory rate -22 breaths / min






SYSTEMIC EXAMINATION : 


Patient examined in sitting position


Inspection:-

Upper respiratory tract - oral cavity- Nicotine staining seen on teeth and gums , nose & oropharynx appears normal. 


Chest appears Bilaterally symmetrical & elliptical in shape

Respiratory movements appear to be decreased on right side and it's Abdominothoracic type. 

Nipples are in 4th Intercoastal space.

Apex impulse visible in 5th intercostal space

No signs of volume loss

No dilated veins, scars, sinuses, visible pulsations. 

No rib crowding ,no accessory muscle usage.

Palpation:-

All inspiratory findings are confirmed by palpation.


PERCUSSION:stony dullness is observed( moderate pleural effusion)


Final Diagnosis : 

1- Right sided Pleural effusion likely infectious etiology. 

2- Hepatomegaly - ? Hepatitis or ? Chronic liver disease 


Investigations : 


X ray findngs-ELLIS curve (s shaped curve/Damoiseaus curve)-curved shadow at the lung base,blunting the costophernic angle and ascending towards the axilla.


Shifting dullness is seen on examination






Liver function test :



Final Diagnosis: 
1-Right sided Pleural effusion - synpneumonic effusion 
2- Right lobe liver abscess(12×11 cm partially liquified)

TREATMENT(conservative):


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