Thanx alot dear doctors for your words ..
My father always telling me :
Every accurate Dx of any case need a :
1- Simple anatomy ..
2- Simple physiology ..
3- & Common sense ..
& the other come by experiance ..

Now, what about this CXR ??


-----------------------
Ahmed A. Al-Jubouri

Well I can see an opacity at the lower lobe of the right lung...

So it would be Lobar Pneumonia

HOWA 9A7EE7 DR. ZAID IT IS PNEUMONIA,BUT I AM SNESING THERE IS SOMETHING ELSE MO? ASHO AL LEFT DOME KOLSH NAZEL .

ALI

Thanx for your replies ..
Well, I think U both ( Dr. Zaid & Dr. Ali ) put the wrong Dx ..
But; this condition could occur as a complication of pneumonia ..

Well, as U see in the this CXR :
There is obliteration of the right costo-phrenic angle, & the there is an opacity of the right lung in the middle zone & it attached to the chest wall & the right dome of the diaphragm, & this opacity begins as a homogenous one & as it ascend upward it becomes a non-homogenous opacity ..
So, It mostly goes with Pleural Effusion ..

& as U know, there are two types of pleural effusion :
1- Free Pleural Effusion ..
2- Encysted ( Localized ) Pleural Effusion ..

& my Dx mostly goes with Encysted ( Localized ) Pleural Effusion, because there is a clear line of demarcation surrounded this effusion ..
& it is not a Free Pleural Effusion, because the abscence of the Meniscus Sign, which is characteristic of Free Pleural Effusion ..

& it could be a Post-Pneumonic Encysted Pleural Effusion, because one the complications of pneumonia is Pleural Effusion ..

I hope this illustration is enough


-----------------------
Ahmed A. Al-Jubouri

7ilwa Ahmed

and with regards for all your great cases but

is one great advice regards for your dad and thanx for sharing the dvice



Farah Baha

Thanx dear Dr. Fara7 for your nice words ..

Now, what about this CXR ( I think it is easy one ) .. & What are the important clinical signs you look for it in such patient ? .. & What are the ECG abnormality in this condition ? .. & How you treat such condition ?? .. & what is the most important complication of such condition ? ..

Enjoy it


-----------------------
Ahmed A. Al-Jubouri

hmm cardaic temponade mo???
sign ??? silhouette sign mo?

mx is pericardiocentisis.

ali

tHE CASE IS CARDIAC TAMPONADE

ON PHYSICAL EXAMINATION YOU WILL LOOK FOR

1. PULSUS PARADOXUS
2.KAUSMAUL SIGN
3. MUFFLED HEART SOUNDS

ECG ABNORMALITY : LOW VOLTAGE WAVES

Rx PERICARDIOCENTESIS

MOST IMPORTANT COMPLICATION DEATH DUE TO PUMP FAILURE CAUSE THE FLUID IN THE PERICARDIUM PREVENTS THE HEART FROM CONTRACTING NORMALLY .

SORRY I DID A MISTAKE

Thanx for your replies ..
But this case is actually not a Cardiac Temponade ..

It is a Pericardial Effusion ..

& as Dr. Fara7 said ....
The physical signs that we look for them in such patient are :
1- Pulsus Paradoxus ..
2- Kassmul's Sign ..
3- Muffled S1 & S2 ..

& ECG shows :
Low voltage QRS complex ..

Treatment :
Treat the underlying cause of it ( as : Viral, Bacterial, & Fungal infection, RA, SLE, Myxedema, MI, Dressler syndrome, Trauma ..... etc ), then we do Pericardiocentesis ( which could be Dxtic & therapeutic ) ..

Imp. Complication :
Cardiac Temponade ..

Thanx for Dr. Fara7 & Dr. Ali for there answer ..

I hope next time our Stagers ( 6th year ) share their answer


-----------------------
Ahmed A. Al-Jubouri

why it is pericardial effusion not tamponade?

how can you determine Ahmed ?

Thanx Dr. Fara7 for this nice question
Actually by CXR, we cannot determine whether this Pericardial Effusion has developed to Cardiac Temponade or not ..

But, I saw this case in the hospital & we send him for Echo., the Echo. show normal ventricular function, so this patient does not develop Cardiac Temponade yet ..
Because if the patient has develped Cardiac Temponade there will be impaired ventricular function ..

I hope this is enough to ensure my point of view ..



-----------------------
Ahmed A. Al-Jubouri

What about this CXR ??


----------------------
Ahmed A. Al-Jubouri

No one can see what is wrong with this CXR ??
It is quite easy ..
Waiting for your answers ..


----------------------
Ahmed A. Al-Jubouri

I'm not sure about it but I think it is Hiatal Hernia coz there is an air fluid level at the cardiac area

I'm waiting for other replies before you put the Dx Ahmed