CASE PRESENTATION-PLEURAL EFFUSION.pptx

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1. CASE PRESENTATION-PLEURAL EFFUSION

2. PATIENT DETAILS NAME : Mrs Vijaya AGE : 43yrs GENDER : Female ADDRESS : Pallavaram OCCUPATION : Homemaker

3. CHIEF COMPLAINTS FEVER : 15 days CHEST PAIN : for initial 3 days BREATHLESNESS : 8days

4. History of presenting illness Apparently normal 15 days back Fever : 15 days, sudden, intermittent, high grade, a/w non productive cough Left sided chest pain: 3days, acute, progressive, pricking, severe on deep inspiration, relieved on lying down on left side Breathlessness: 8 days, grade1, acute, static, aggravated on climbing stairs, relieved on tapping No History suggestive of orthopnoea , PND

5. PAST HISTORY Not a known case of DM, HTN, contact with TB, Asthma Medical history: no history of chronic drug intake Single history of tapping done 1 week back Surgical history: no relevant surgical history Personal history: Mixed diet; Normal sleep and appetite; normal bowel and bladder habit; no adverse social habit

6. Menstrual history: Regular cycle – 3-5/28 days; No dysmenorrhoea; LMP – 19/10/17 Family history: Not significant Occupational history: Home maker Summary: 43 year old female presented with chief complaints of fever, MMRC grade 1 breathlessness, chest pain for 15 days with one episode of tapping done

7. General examination Patient conscious, oriented to time place and person Moderately built, moderately nourished, comfortable; consent obtained Vital signs: Pulse: 98 beats/ min; regular; normal volume; no specific character; no radio radial or radion femoral delay; condition of vessel wall normal; all peripheral pulses are felt BP – 130/90 mmHg measured on right upper arm, sitting posture RR – 26 / min; thoraco – abdominal type afebrile

8. No pallor No icterus No cyanosis No clubbing No generalised lymphadenopathy No pedal edema No external markers of TB present

9. Local examination consent obtained; Exposed upto umblicus ; Upper respiratory tract: Nose: no DNS, no polyp, no discharge Para nasal sinus: no tenderness elicited Oral cavity: no tonsilar enlargement; no ulcer; no dental caries, no loosening of tooth Ear - Normal

10. Inspection No chest wall deformity; Chest wall bilaterally symmetrical; Trachea seems to be in midline Apical impulse not visible Chest wall moves equally on both sides Accessory muscles not involved; No inter costal fullness; no engorged veins; no scars, no sinuses; JVP not elevated

11. Palpation Inspectory findings are confirmed Trachea is midline in position Apical impulse felt in left fifth intercostal space, half an inch medial to clavicular line Chest wall movement reduced in left side; Tenderness present over the left hemithorax

12. Measurements Antero posterior diameter: 21 cm Transverse : 26 cm Ratio = 5:7 Thorax Measurement Deep inspiration Expansion Total 79 cm 81 cm 2 cm Left hemithorax 40 cm 40 cm No change Right hemithorax 39 cm 41 cm 2 cm

13. Vocal fremitus Area Right Left Supra clavicular Normal Normal Infra clavicular Normal Normal Mammary Normal Reduced Axillary Normal Reduced Infra axillary Normal Reduced Supra scapular Normal Normal Inter scapular Normal Reduced Infra scapular Normal reduced

14. Percussion Area Right Left Direct percusion over clavicle resonant Resonant Infra clavicular Resonant Resonant Mammary Resonant Stony dull Axillary Resonant Stony dull Infra axillary Resonant Stony dull Supra scapular Resonant Resonant Inter scapular Resonant Stony dull Infra scapular Resonant Stony dull Traube space: impaired Shifting dullness: present Straight line dullness: absent Tidal percussion: resonant on deep inspiration

15. Auscultation Bilateral air entry present Air entry Reduced on left side – mammary, axillary , infra axillary , inter scapular, infra scapular areas Normal vesicular breath sounds heard No added sound

16. Vocal resonance Area Right Left Supra clavicular Normal Normal Infra clavicular Normal Normal Mammary Normal Reduced Axillary Normal Reduced Infra axillary Normal Reduced Supra scapular Normal Normal Inter scapular Normal Reduced Infra scapular Normal Reduced

17. Other systems CVS : S1, S2 heard; no murmer Abdomen : soft, no organomegaly CNS: no focal neurological deficit Diagnosis : Left sided moderate pleural effusion infective in etiology , probably tuberculosis involving the pleural space

18. Investigation Baseline: Complete hemogram : RBC count, TC, DC, Hb , ESR Urine routine Mantoux test Chest X ray Diagnostic: Diagnostic pleural tapping - gram staining, culture, AFB smear, cytology, pH, amylase level, glucose, LDH, SFAG

19. Treatment Control infections with antibiotics Treat TB – DOTS regimen category I Diuretics Thoracocentresis and draining of fluid Surgical: if needed

20. Thank you....