Showing posts with label Case of the week. Show all posts
Showing posts with label Case of the week. Show all posts

Chest Challenge: chest x ray spotter

By Dr Deepu
This is a chest X ray of a 60 year old male. Presenting with history of alleged fall and right sided chest pain. His X rays are displayed here. The two X rays are 3 days apart. Observe the X rays and answer these questions.




1.What is your diagnosis?
2.The second X ray has worsened than the first one. What is the cause?
3. What can we expect in the CT thorax?

Kartageners Syndrome

By Dr Deepu
See the question
The answer is b."Kartagener syndrome"

Kartagener syndrome is the inheritable disorder of dextrocardia, chronic sinusitis (with the formation of nasal polyps), and bronchiectasis. Patients may also present with situs inversus.The disorder is due to a defect that causes the cilia within the respiratory tract epithelium to become immotile. Cilia of the sperm are also affected

CASE OF THE WEEK- "Chest Medicine challenge"- case no 03( 24th April- 1st May).

Pulmonary Medicine Blog By Dr Deepu

A 20-year-old woman comes to the ED with a 2-week history of gradually progressive shortness of breath, orthopnea, and dysphagia. She reports an 18-lb (8 kg) weight loss and subjective fevers over the same period of time. She also describes chest tightness and a nonproductive cough. The patient was empirically treated by her private physician with a course of antibiotics without improvement 7 days ago. She was told that there was an abnormality on her chest radiograph and a chest CT scan was performed, but she did not follow up on the results. She is a never-smoker and has no history of asthma. On physical examination, the patient is in mild-to-moderate respiratory distress with a respiratory rate of 32/min; BP, 152/84 mm Hg; and pulse rate of 130/min. Her temperature is 38.4° C. Neck examination reveals jugular venous distention. On lung examination, there is diff use wheezing. Her current posterior-anterior and lateral chest radiographs are shown (Figs 1-A, 1-B). A chest CT scan is ordered, but the patient becomes more short of breath (accentuated when supine in preparation for the CT scan), restless, and confused. Her respiratory rate increases to 40/min, and her oxygen saturation is 88% when breathing 50% oxygen by face mask.

The next step in this patient’s management should be:

A. Awake intubation in the semiupright position.
B. Rapid sequence intubation.
C. Noninvasive mechanical ventilation.
D. Emergency tracheostomy.
also comment on the CT and Chest X Ray

Please come back on Tuesday for answer.

CHEST RADIOLOGY

Air Bronchogram Sign.





Chest Medicine Challenge-02, Case of The week ( 11-17th April)- Answer

Pulmonary Medicine blog

Its Tuesday and here is the answer for the chest Medicine challenge 2.
Raise your hand if you answered D to Friday's CHEST Challenge question! Nice work! Read on for complete rationale.
A 45-year-old nonsmoking woman was referred for an opinion regarding management of recurrent pneumothorax. She was well until age 27 when she had a right-sided spontaneous pneumothorax. Two years later, she had another right-sided pneumothorax and underwent thoracotomy and stapling of the right lung apex. She has had no further episodes since that time. She is seeing a dermatologist for multiple facial papules, but otherwise, her general health is excellent. She denies any respiratory symptoms. Results of a physical examination are normal other than multiple skin-colored papules over the central face and nose. Results of a chest radiograph demonstrated right apical pleural thickening but were otherwise normal. A chest CT was performed and representative images are shown in Figures 138-A and 138-B. Her lung function was normal. The most likely diagnosis of this condition is:
A. Langerhans cell histiocytosis.
B. Lymphangioleiomyomatosis (LAM).
C. Sarcoidosis.
D. Birt-Hogg-Dubé syndrome (BHDS).


The CT scan reveals several cysts in the left lung and scarring at the right apex related to the previous surgery. A history of recurrent pneumothorax, lung cysts, and skin lesions (fibrofolliculomas) with normal lung function is consistent with the diagnosis of Birt-Hogg-Dubé syndrome (BHDS) (choice D is correct). Langerhans cell histiocytosis is characterized by diffuse cystic disease of the lung, spontaneous pneumothorax, and airway obstruction related to cigarette smoking. These findings are not present in this patient (choice A is incorrect). Similarly, airflow obstruction, recurrent pleural effusions, and diff use pulmonary disease are characteristic of LAM, features that also are not found in this patient (choice B is incorrect). Sarcoidosis is a granulomatous inflammatory lung disease characterized by diff use parenchymal opacities, airflow obstruction, and possibly, skin lesions. Lupus pernio, one of the skin manifestations of sarcoidosis, appears as purple nodules on the nose, cheeks, and ears, and none of these features is present in this patient (choice C is incorrect).
BHDS is an autosomal dominantly inherited genodermatosis that predisposes a person to the development of cutaneous hamartomas (fibrofolliculomas), kidney neoplasms, lung cysts, and spontaneous pneumothorax. The BHD locus has been mapped to the short arm of chromosome 17(17p11.2). BHD is composed of 14 exons, and more than 40 unique mutations in BHD have been reported. Most BHD germline mutations are frameshift or nonsense mutations that are predicted to truncate the BHD protein, folliculin. Patients exhibit multiple 1- to 5-mm white-colored or skin-coloured papules distributed over the face, neck, and/or upper trunk, which histologically, are fibrofolliculomas (Fig 138-C). BHDS is associated with a unique histologic spectrum of bilateral and multifocal kidney tumors ranging from hybrid oncocytic (67%) to chromophobe renal carcinoma (23%) to oncocytic renal carcinoma (3%). Clear cell renal cell carcinoma (3%) has also been reported in a few patients with BHDS. Pulmonary manifestations are a major feature of BHDS. Most patients who are affected (89%) have multiple pulmonary cysts. The number of lung cysts is clearly related to the risk of pneumothorax. Approximately one-quarter of patients with BHDS have a history of one or more pneumothoraces. Smoking does not appear to be a risk factor for pneumothorax in this population.
Toro JR, Wei1 MH, Glenn GM, et al. BHD mutations, clinical and molecular genetic investigations of Birt-Hogg-Dubé syndrome: a new series of 50 families and a review of published reports. J Med Genet. 2008;45(6):321-331.
Toro JR, Pautler SE, Stewart L, et al. Lung cysts, spontaneous pneumothorax, and genetic associations in 89 families with Birt-Hogg-Dubé syndrome. Am J Respir Crit Care Med. 2007;175(10):1044-1053.

Pavlovich CP, Grubb RL III, Hurley K, et al. Evaluation and management of renal tumors in the Birt-Hogg-Dubé syndrome. J Urol. 2005; 173:1482-1486.

Chest Medicine Challenge-02, Case of The week ( 11may-17th may)

It is Friday and it is the time to test yourself. Here is the case of the week for 17th-24th may, please come back on Tuesday for answers..

A 45-year-old nonsmoking woman was referred for an opinion regarding management of recurrent pneumothorax. She was well until age 27 when she had a right-sided spontaneous pneumothorax. Two years later, she had another right-sided pneumothorax and underwent thoracotomy and stapling of the right lung apex. She has had no further episodes since that time. She is seeing a dermatologist for multiple facial papules, but otherwise, her general health is excellent. She denies any respiratory symptoms. Results of a physical examination are normal other than multiple skin-colored papules over the central face and nose. Results of a chest radiograph demonstrated right apical pleural thickening but were otherwise normal. A chest CT was performed and representative images are shown in Figures 138-A and 138-B. Her lung function was normal. The most likely diagnosis of this condition is:
A. Langerhans cell histiocytosis.
B. Lymphangioleiomyomatosis (LAM).
C. Sarcoidosis.
D. Birt-Hogg-Dubé syndrome (BHDS).

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PLEASE ANSWER IN THE COMMENTS SECTION BELOW.
RETURN BACK ON TUESDAY FOR ANSWERS

Its Tuesday

The answer is D.Birt-Hogg-Dubé syndrome (BHDS).Read The complete Rationale Here

Case of the week- Chest Medicine challenge - Case 1

Here is the case of the week with history. The questions will be posted on Friday and the answer will be updated on subsequent Tuesday. See the archives of case of the week in the TOPICS.

A 72-year-old man is admitted for increased shortness of breath, a cough productive of yellow sputum with scant hemoptysis, left pleuritic chest pain, and low-grade fevers. His past medical history is notable for hypertension and diabetes. He has a history of 80 pack-years of tobacco use, and was a ship-yard worker while in the military. On physical examination, his temperature is 38°C and his lung examination reveals decreased breath sounds on the left. His frontal and lateral chest radiographs are shown in Figure 158-A and Figure 158-B. What do you expect to observe on the chest CT scan?
A. Left pleural effusion.
B. Left upper lobe (LUL) consolidation.
C. LUL collapse.
D. Pleural thickening.

Click on the Image to enlarge


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 Please come back on Tuesday for the answer.

Its Tuesday. Click here for answers Chest Medicine challenge case 1

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