CASES for CR session on

Tue 12-10-10
Dr.Moeen
 CASE 1
• 35 year old man

• Complains of :
Edema all over the body
Shortness of breath
Fatigue
• On Examination:

Pitting edema on the lower limbs

Shifting dullness in abdomen

 CHEST EXAMINATION:

• Symmetric with reduced chest movements on

the left side

• Reduced tactile vocal fremitus on left lower

chest with trachea shifted to right

• Stony dull percussion note on left lower chest

• Absent breath sounds on left lower chest with

absent vocal resonance
• CBC …
Total leucocyte count … 8000/cmm
with normal differential count

• Blood urea … 40 mg/dl (N 20-40)

• Serum Creatinine .. 0.5 mg/dl (N upto 1.2)

• Pleural fluid analysis ….

clear
specific gravity 1012
cells 25/cmm mostly mononuclear
protein 0.8 g/dl
LDH 150 IU/dl
• Urine analysis shows proteinuria ++++
 QUESTIONS
• What is the differential diagnosis of this
effusion?

• What is the likely cause of Effusion in this

patient?

• How would you manage?

 CASE 2
• 40 Year old man from Bangladesh

• Past history of
low grade fever
cough and sputum for 2 months

• Presents with
shortness of breath
right sided chest pain …. For 3 days
• On examination:
Pallor +
Chest examination:
Reduced chest movements on the right side with a bulge

Reduced tactile vocal fremitus on right side with central

trachea

Stony dull percussion note on right lower chest

Crackles at the right upper chest

Absent breath sounds at right lower chest and absent
vocal resonance
• CBC …
Total leucocyte count … 6000/cmm
with Lymphocyte 50%

• Pleural fluid analysis ….

straw coloured
specific gravity 1025
cells 5000/cmm mostly mononuclear
protein 4.5 g/dl
LDH 250 IU/dl

• Sputum AFB smear +

 QUESTIONS
• What is the differential diagnosis?

• What further investigations you would do?

• What is the likely cause of effusion in our

patient?

• How would you manage?

 CASE 3
• 55 Year old man

• Heavy smoker for 30 years

• History of chronic cough with sputum for 5 years;

sputum blood tinged for the last few months;
weight loss of 10 kg over 3 months

• Presents with sudden shortness of breath for 2

days
• On examination:
Pallor +
Finger clubbing +

Chest:
Absent chest movements on the right side with a
bulge

Absent tactile vocal fremitus on right side with central

trachea

Stony dull percussion note on right side of chest

Absent breath sounds on right side of chest with

absent vocal resonance
• CBC …
Hemoglobin 6 gram/dl

• Pleural fluid analysis ….

Red and turbid
specific gravity 1025
White cells 25000/cmm mostly
mononuclear
RBCs 50,000/cmm
protein 4.5 g/dl
LDH 250 IU/dl
 QUESTIONS
• What is the likely cause of Effusion in the
patient?

• What further investigations can be done?

• Management?