CLINICO PATHOLOGICAL CORRELATION

SARATHCHANDRAN K
PATIENT DETAILS

 Mr . X
 20 YEAR OLD MALE
 PRESENTING COMPLAINTS

 Sudden onset breathing difficulty * 4 days back

 Cough initially non productive and later productive * 10 days

 Chest pain * 5 weeks

 Generalised agitation , decreased sleep * 6 weeks

8
month
6 8
weeks month
 8 month back

Diagnosed to have BPAD

Was on medication for same

NO drug default

5 6
week weeks
 6 week back
Generalised hyperactivity and difficulty in sleep
According to bystander

Aslo they noticed he had decreased sleep

So he was brought to local psychiatric hospital and he was admitted

5 8
week month
 5 5weeks
week back
back
One day prior to chest pain , he had a quarrel with other inmated and sustained injury
Chest pain
to left chest
Insidious onset mild pain
Localised in lateral aspect of lower chest in left side
So CT chest was taken –
Pricking type of pain
Increased
CT CHEST with
= respiratory movements
Not associated with any autonomic symptoms , No radiation of pain
Ground glass opacities in left lower lobe
They made a diagnosis of pulmonary contusion

10 days 6 8
weeks month
 10 10
days back
days back
Cough non productive to start with later became productive – mucoid sputum
He wasonset
Insidious brought to a local hospital
Progressive in intensity
NoXdiurnal
ray wasvariantion
taken =
Left consolidation
Not associated any fever , loss of weight , loss of appetite .
Left pleural effusion
Chest pain also persisting
Heiswas
Pain given oral
increases withantibiotics
coughing and send home

1 5 6 8
day week weeks month
1CT
day back
ANGIOGRAM

Sudden
EMBOLI onset breathing
in right and leftdifficulty
pulmonary
Associated
arteries thatwith chest
extend intodiscomfort
multiple and giddiness
Sweating
segmentalpresent
and subsegmental branches .
wedege shaped opacities in left uppervand
lower lobes
Brought -infarction
to hospital

Vitals =
He was initiated on heparin , IV fluids and other supportive measure
PR - 127 SPO2- 90 with RA BP- 90/50 mmhg RR- 26
He was referred to 2 nd hospital for further management

10 Days 5 6
week weeks
No history of fever , chiils , rigor
No history of any seizure

1 10 days 5
day week
Past history
Past history of ADHD in childhood
Asthma for last 2 years on MDI
Migraine for last 1 year not on any medication
BPAD for last 8 months
No history or joint pain , rash ,

1 10 days
day
 Family history

His mother ,maternal aunt , paternal aunt had depression

No history of connective tissue disease in family
No history of

Personal Past 1
history hisory day
Personal history

Mixed diet
Normal bowel and bladder habits
Sleep reduced
Normal appetite
Occasional alcoholic and occasional smoker

Past
Family
hisory
history
 WHAT WE HAVE SO FAR……

20 year old male

With family history of depression
Past history of ADHD in childhood , asthma , migraine and recently diagnosed BPAP
Now presented to us with pulmonary embolism and URE showing RBC and proteinuria

How to approach
Pulmonary involvement Renal involvement CNS involvement

Multisystem disorder

Infective or Inflammatory
 DIFFERENTIAL DIAGNOSIS
Inflammtory casuses

VASCULITIS – ANCA Anti GBM disease

SLE Associated
 DIFFERENTIAL DIAGNOSIS
Infective casuses

Infective endocarditis
EXAMINATION

 Conscious oriented in time place and person

 Moderately build and nourished
 Height = 182 cm ,
 Weight = 70 kg
 BM1 = 21.13kg/m2
 Arm span = 177 cm
GENERAL EXAMINATION

 VITALS
 PULSE – 127/min , regular , normal volume , character, no Radio – radial delay , no radio
femoral delay, all peripheral pulsations are felt equally and bilaterally , condition of vessel wall
normal
 BP – 100/60 mmhg at right arm supine position
 RESPIRATORY RATE = 14 /min , abdominothoracic
 SPO2 = 99 with RA
 TEMPERATURE = afebrile
RESPIRATORY SYSTEM
CARDIOVASCULAR SYSTEM
GASTROINTESTINAL SYSTEM
CENTRAL NERVOUS SYSTEM
Family Past
history hisory