A Patient with lack of resolution of persistent cough, shortness of breath and now complains of Lack of appetite

 The complete case can be found here

https://a-blog-by-adityarayilla.blogspot.com/2020/06/left-sided-pleural-effusion-case.html?m=1


What are the possible differential diagnoses?


    chronic obstructive pulmonary disease (COPD)asthma,

    pulmonary fibrosis

    Congestive heart failure

    pulmonary thromboembolism

    pneumonia

    neuromuscular disease

    left pleural effusion


points in favour and against each diagnosis at this point of time.


pleural effusion


    heaviness on left side

    cheast pain

    shortness of breath

    decrease breath sounds on left side


congestive heart failure


    pedal edema

    dyspnea

    decreased urine output

    against: no orthopnea or PND


chronic obstructive pulmonary disease


    dyspnea

    beedi smoker


pneumonia


    dyspnea

    against: patient is afebrile


pulmonary thromboenbolism


    dyspnea

    against: not sudden oncet, no embolic risk factors


renal failure


reference: davidson principles and practice of medicine chapter on respiratory medine


Out of all differential diagnoses, most likely is.

pleural effusion is most likely as heaviness is classic of pleural effusion


More information about history and examination to reach the final diagnosis

diffrential diagnosis for left sided pleural effusion include


Pneumonia (‘parapneumonic effusion’)


    any history of fever


Tuberculosis


    socioeconomic status of patient

    family history of TB


Subdiaphragmatic disorders (subphrenic abscess, pancreatitis etc.)


    abdominal pain


Malignant disease


    weightloss - loosening of clothes

    previous diagnosis of malignancy

    smoking


nephrotic syndrome - CKD


    JVP

    any pleural friction rub

    brown line on nails

    signs of perepheral neuropathy

    easy brusing

    pruritus

    preitoneal dialysis catheter


Post-myocardial infarction syndrome


    history of angina


Asbestos-related benign pleural effusion


    history of work in asbestos industry



Investigations

Chest xray, CT chest


    evaluate TB

    evaluate pleural effusion

    evaluate pneumonia

    evaluate COPD


renal function tests


    confirm CKD


pleural tap


    find the cause weather it is exudative or transudative effusion


LFT, complete haemogram


Diagnosis

Chest xray shows oblitration of costo diaphragmatic angle and fluid level on left side suggesting pleural effusion.


HRCT shows, endobronchial infection on left side and chronic kidney disease at left kidney


pleural tap analysis


high lumphocyte count and high protien suggests tubercular pleural effusion

reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6542220/

        davidson table 15.29


final diagnosis

pulmonary tuberculosis with CKD


Treatment

anti tubercular treatment

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