View
228
Download
0
Category
Preview:
Citation preview
8/17/2019 Karthik Radiology Presentation.pptx
1/33
RADIOLOGYPOSTING
CASEPRESENTATIONPRESENTER :KAARTHIGAN
RAMAIAHID NO. : 06-201204-00011LECTURER :
DR.AZMAN
8/17/2019 Karthik Radiology Presentation.pptx
2/33
1. History taking
2. Physical examination
3. Provisional diagnosis
4. Diferential diagnosis5. Investigation
6. anagement !lan
". Disc#ssion and learning o#tcomes
$. %e&erences
'()*+)*
2
8/17/2019 Karthik Radiology Presentation.pptx
3/33
Pati!t"# $tai%#
)ame , -an Dayang emi
ge , 4/ years o ld
%ace , alay
0ender, emale
ddress, *an#ng 0ading #ar
(cc#!ation, Ho#sei&e
Date o& admission, 26/42/16
Date o& clerking, 2$/42/16
'hie& com!laint
hortness o& 7reath &or 3 eeks
Hi#t&'( &) *'#!ti!+i%%!##:
Patient is a knon case o&hy!ertension and !le#ral
t#8erc#losis. Patient started tohave shortness o& 8reath 3 eeksago. he claimed that it isorsening on sitting and aking8#t not at rest. Patient also!resented ith ortho!noea and!aroxysmal noct#rnal dys!noeasince 3 eeks ago. he needs toslee! #sing 3 !illos. Patient alsoadded that she also had decreasedefort tolerance since 3 eeks ago.he said it started to orsen 2eeks ago in hich !atient claimedthat she started &eeling lethargya&ter alking aro#nd 3/ metres.
HI*(%9 *:I)0
3
8/17/2019 Karthik Radiology Presentation.pptx
4/33
Patient also !resented ithon and of giddiness.Patient said that she startsto vomit and &eelsna#seated only a&ter taking
anti;*7 dr#gs. Patient saidthat she lose $/kg to 4/kgin this 3 years time.(therise !atient denied8l#rring o& vision &everco#gh chest !ain and!al!itation.
Pa#t ,$ia% i#t&'(
*#8erc#losis
Diagnosed 6 months ago
Patient is having rec#rrent !le#ralef#sion.
he has done !le#ral ta!!ing &or 16times d#e to this.
Patient as !laced #nder a
treatment regimen &or 6monthsatest 8lood !ress#re reading is1"6?/ mmHg
*aking medi cations &o r it
'om!liant
o &ar no com!lication &romhy!ertension like headache!al!itation or 8l#rring o& vision
)o :non edical Illness
4
8/17/2019 Karthik Radiology Presentation.pptx
5/33
Pa#t #/'+ia% i#t&'( >oer segment caesarean
section
Done in 2//$ and 2/13 to!revent com!lications as !atienthad !revio#s history 5miscaria ge histo ry.
(ther than that no others#rgeries ere done.
D'/+ i#t&'( a!$ a%%'+( *. 'alci#m car8onate 5//mg *D
*. Pyra@inamide 5//mg +(D
*. mlodi!ine 5mg (D *. e rro#s #marate 2//mg (D
olic acid 5mg (D
Aitamin 7 11 (D
*. Isonia@id 3// mg (D
*. %i&am!icin 3// mg (D
*. Pyridoxine 5/ mg (D
*. +tham8#tol H'l 4//mg +(D
a,i%( i#t&'( ather !assed aay at the age o& 63
d#e to myocardial in&arct ion.
other is st i l l a l ive and is 62 yearsold ith h istory o& d ia8etes mel l i t#s
and hy!ertension. $ si8 l ings 5 males and 3 &emales
ith )o :non edical I l lness.
S&ia% i#t&'( Pat ient l ives in v i l lage area.
Pat ient c la imed that o!en 8#rningha!!ens constantly.
Pat ient gets a clean ater s#!!ly.
Pat ient has no &ood al lergy ando8serves a normal 8alanced diet .
Pat ient h#s8and is a smoker 8#tdoesnBt smoke in & ront o& !at ient .Pat ient is not an alcohol ic.
Pat ient also cla imed that there is no!ets in her ho#se
Pat ient c la imed that no one in her
&ami ly has *7 and also her & r iends. 5
8/17/2019 Karthik Radiology Presentation.pptx
6/33
Patient as alert !ink and thin and eak there as acann#la inserted on the le&t hand.
ita% #i+!# , *em!erat#re, a&e8rile
7lood !ress#re, 1"6?/
P#lse rate, $5 8!m reg#lar rhythm ith normal character andvol#me.
%es!iratory rate, 16 8!m
I!#*ti&!
)o !eri!heral cyanosis no (slerCs node no ane ayBs lesion. *he !eri!hery as cold. )o con#nctival !allor and scleral a#ndice oral hygiene acce!ta8le no central cyanosis.
A not distended. )o any visi8le !#lsation o& neck.
'hest, no any chest de&ormities no any s#rgical scars and novisi8le !#lsation
PH9I'> +EI)*I()
6
8/17/2019 Karthik Radiology Presentation.pptx
7/33
Pa%*ati&!
*rachea is not deviated
*he cricosternal distance is 3 Fnger 8readths
!ex 8eat is &elt at 5th intercostal s!ace along mid;
clavic#lar line'hest ex!ansion as good
*actile vocal &remit#s; increased on the right area
P'/##i&!
nterior D#ll so#nd heard on right loer @one
Posterior D#ll so#nd heard on right loer @one
"
8/17/2019 Karthik Radiology Presentation.pptx
8/33
A/#/%tati&! 7ronchial 8reathing as heard
Decreased air entry on the right com!artment
)o rhonchi or 8asal cre!itation
*actile vocal &remit#s; increased on the right area +nd ith P+% #rine di!stick
$
8/17/2019 Karthik Radiology Presentation.pptx
9/33
P%/'a% T/'/%i#
Positive Fndings
Previo#s history o& !le#ral ef#sions shortness o& 8reath
decreased efort tolerance
lethargy
loss o& eight
Perc#ssion revealed d#ll so#nd heard on right loer @one on8oth anterior and !osterior chest all
#sc#ltation revealed 8ronchial 8reathing decreased air entryon the le&t com!artment and tactile vocal &remit#s; increasedon the right area
P%(AII()> DI0)(I
?
8/17/2019 Karthik Radiology Presentation.pptx
10/33
1. Pne#monia
• igns o& lo8ar or aty!ical !ne#monia s#ch as dys!noea.0enerally shorter d#ration o& sym!toms com!ared ith *7.
2. arcoidosis
• (ther &eat#res o& sarcoidosis s#ch as intrathoraciclym!hadeno!athy and arthralgias may 8e !resent.
3. #ngal in&ection
• Potential ngi incl#de histo!lasmosis coccidioidomycosisand 8lastomycosis. *ravel history may hel! narro the
diferential diagnosis
DI+%+)*I> DI0)(I
1/
8/17/2019 Karthik Radiology Presentation.pptx
11/33
7lood investigations
I)A+*I0*I()
)ormal 7' Fnding.
Patient is slightlyanemic.
ULL 3LOOD
COUNT
RESULT REERENCE RANGE
H 1/.3gd> 11.5;15.5
TR3C 3.6 x 1/6#> 3.$;5.$
PC 31.$ G 3";4"
MC $$.$ &> "6;?6
MCH 2$.6 !g 2";32
MCHC 32.2 gd> 3/;35
PLT 2$4 x1/3#> 15/;4//
T3C $.1 x 1/3
#> 4;11
N/t'&*i% 63.6 G 5.15G 2;".5
L(,*&(t 24.2 G 1.?6G 1.5;4
M&!&(t 5.5 G /.45G 2;1/
Ei!&*i% 5." G /.46G 1;6
3a#&*i% 1./G /./$G /./2;/.1
11
8/17/2019 Karthik Radiology Presentation.pptx
12/33
)ormal res#lts o&>iver #nction *est.
LIER UNCTION
TEST
RESULT REERENCE
RANGE
TOTAL PROTEIN "3 g> 65;$5
AL3UMIN 3? g> 35;5/
GLO3ULIN 34 g> 2/;35
A5G RATIO 1.1 g> 1./;2.2
TOTAL 3ILIRU3IN " #moll P *( 22.2
ALKALINE
PHOSPHATASE
$4 > 3/;12/
ALANINE
TRANSAMINASE
15 > P *( 32
RENAL
PROILE
RESULT REERENCE
RANGESERUM
CREATININE
"/ #moll 53;1//
UREA $ mmoll 2.5;$.3
SODIUM 134
mmoll
135;145
POTASSIUM 4./
mmoll
3.5;5./
CHLORIDE ?5 mmoll ?$;1/$
)ormal res#lts o&%enal ProFle.
12
8/17/2019 Karthik Radiology Presentation.pptx
13/33
>DH is slightly high.(ther than that normal'ardiac +n@ymesval#es.
CARDIAC ENZYMES RESULT REERENCE
RANGE
CREATINE KINASE 53 > 25;2//LACTATE
DEHYDROGENASE
254 > 11/;24$
ASPARTATE
TRANSAMINASE
13 > P *( 4/
CALCIUM 2.16 mmoll 2.1;2.6INORGANIC
PHOSPHATE
1./ mmoll /.$";1.45
COAGULATION RESULT REERENCE
RANGEPT 11."/ ?.56 11./5
INR 1.14
APTT 36.2/ 2?.5 4/.?
)ormal res#lts o&'oag#lation ProFle
13
8/17/2019 Karthik Radiology Presentation.pptx
14/33
Ple#ral K#id sam!le &or examination
8/17/2019 Karthik Radiology Presentation.pptx
15/33
I0I)0
8/17/2019 Karthik Radiology Presentation.pptx
16/33
*aken on 2642/16
indings
P vie 'h est E;ray.
*aken in erect !osit ion ith no rotation and the F lm is adeL#ately!enetrated.
*he F lm is adeL#ately ins!ired and the l#ng F eld is clear. *he cardiacthoracic ratio is M5/G.
7ilateral l#ng hilar visi8le ith 8l#nted right costo!hrenic angle ithradio;o!acity loer @one o& r ight l#ng.
>#ng is hy!erinKated and the trachea is central ly located and nodeviation. )o consol idation and no sign o& air #nder dia!hragm.
*here is no ortic ne#rysm no dilated !#lmonary tr#nk normal
heart orientation no dextro;cardia and the a!ex is located in the le&t.
Im!ression D#e to 8l#nted costo!hrenic angle and radioo!acity there might 8e a K#id
collection
)o cardiomegaly.
16
8/17/2019 Karthik Radiology Presentation.pptx
17/33
1"
8/17/2019 Karthik Radiology Presentation.pptx
18/33
*aken on 2"42/16
indings
P vie 'h est E;ray.
*aken in erect !osit ion ith no rotation and the F lm is adeL#ately!enetrated.
*he F lm is adeL#ately ins!ired and the l#ng F eld is clear. *he cardiacthoracic ratio is M5/G.
7ilateral l#ng hilar visi8le ith 8l#nted right costo!hrenic angle ithradioo!acity loer @one o& r ight l#ng.
>#ng is hy!erinKated and the trachea is central ly located and nodeviation. )o consol idation and no sign o& air #nder dia!hragm.
*here is no ortic ne#rysm no dilated !#lmonary tr#nk normal
heart orientation no dextro;cardia and the a!ex is located in the le&t.
Im!ression D#e to 8l#nted costo!hrenic angle and radioo!acity there might 8e a K#id
collection
)o cardiomegaly.
1$
8/17/2019 Karthik Radiology Presentation.pptx
19/33
2642/16 2"42/16
'(P%I()
1?
8/17/2019 Karthik Radiology Presentation.pptx
20/33
I0I)0
8/17/2019 Karthik Radiology Presentation.pptx
21/33
*aken on 1622/16
indings
Image L#ality is degraded 8y 8reathing arte&act.
*here is moderate amo#nt o& !le#ral ef #sion noted in the
right hemithorax. *he K #id is homogeno#s in density hich meas#res M2/H.
)o !ockets o& air or so&t tiss#e mass ithin the ef #sion.
*he !le#ral lining is homogeno#sly thin and non;enhancing. *here is a colla!se consolidation o& the medial segment o& the right
middle lo8e and 8asal segment o& the right loer lo8e ith air
8ronchograms.)o l#ng mass seen in the right l#ng.
)o l#ng nod#le or cavitating lesion seen in the right #!!erlo8e or the rest o& the middle and loer lo8e.
21
8/17/2019 Karthik Radiology Presentation.pptx
22/33
)o &ocal lesion in the le&t l#ng.
Heart is enlarged. )o !ericardial ef#sion.
*he vis#alised liver is enlarged. )o &ocal liver lesion
)o signiFcant enlarged lym!h node in the #!!er
a8domen. *he !ancreas gall8ladder and adrenal glands are
normal.
Im!ression
'olla!se consolidation right middle lo8e and 8asalsegment o& the right loer lo8e ith moderate !le#ralef#sion. )o l#ng mass or cavitating lesion.
'ardiomegaly.
22
8/17/2019 Karthik Radiology Presentation.pptx
23/33
PH%'(>(0I'>,
%ecommendation on d#ration o& +P*7 treatment 8y -H(are,;
N regimen sho#ld contain 6 months o& ri&am!icin, 2H%O+4H%
)0++)* P>)
23
8/17/2019 Karthik Radiology Presentation.pptx
24/33
(thers,;
1. trict I( chart
2. l#id restriction
3. -eigh daily
4. %eg#lar +
5. trict 8edrest
24
8/17/2019 Karthik Radiology Presentation.pptx
25/33
#mmary
It is a 4/ years old alay &emale ho is a knon case o&hy!ertension and also !le#ral t#8erc#losis ho as admittedd#e to shortness o& 8reath &or 3 eeks hich as associatedith ortho!nea decreased efort tolerance !aroxysmal
noct#rnal dys!nea lethargy giddiness and loss o& eight.Patient is an non;smoker and non;alcoholic.
(n !hysical examination her !#lse rate as in reg#lar rhythmith normal character and vol#me. (n !al!ation tactile vocal&remit#s; increased on the right area. (n !erc#ssion d#ll so#nd
as heard on right loer @one. (n a#sc#ltation 8ronchial8reathing as heard decreased air entry on the rightcom!artment tactile vocal &remit#s; increased on the right area.
E ray F nding, r ight loer @one ef #sion
>+%)I)0 (*'(+ )DDI'I()
D+I)I*IA+ DI0)(I, P>+%> *7+%'>(I25
8/17/2019 Karthik Radiology Presentation.pptx
26/33
26
8/17/2019 Karthik Radiology Presentation.pptx
27/33
2"
8/17/2019 Karthik Radiology Presentation.pptx
28/33
2$
8/17/2019 Karthik Radiology Presentation.pptx
29/33
2?
8/17/2019 Karthik Radiology Presentation.pptx
30/33
3/
8/17/2019 Karthik Radiology Presentation.pptx
31/33
Ple#ral *7
Q In cl inical !ractice #ltrasonogra!hy
8/17/2019 Karthik Radiology Presentation.pptx
32/33
8dominal *7
*he imaging modal it ies most ly #sed in the investigation are '* and8ari#m st#dies.
Q *he diagnostic yields &or the dif erent modal it ies are $3G &or 8ari#mmeal &ollo thro#gh $/G &or '* and ""G &or .
Q eat#res s#ggestive o& a8dominal *7 are ascites
8/17/2019 Karthik Radiology Presentation.pptx
33/33
*H): 9(
33
Recommended