Questions

1) Describe the finding in the chest x ray2) What is your radiological diagnosis3) What is your provisional and differential

diagnosis Answer

1) Findings on CXR - Blunted of right cardiophrenic and

costophrenic angle - Blunted left costophrenic angle- Trachea is not shifted - Opacity at right lung field.

2) Bilateral pleural effusion 3) Diagnosis

Provisional: Bilateral pleural effusion secondary to fluid overload Differential of bilateral pleural effusion- Heart problem - Liver problem - Neurogenic APO - Sub arachnoid hemorrhage- SIADH

A Lady with Underlying Chronic Renal Disease presented with Shortness of Breath

Describe the finding in the chest x ray What is your radiological diagnosis

provisional and differential

Blunted of right cardiophrenic and

Blunted left costophrenic angle

Opacity at right lung field.

Bilateral pleural effusion secondary to fluid overload

Differential of bilateral pleural effusion

Sub arachnoid hemorrhage

Notes To differentiate exudates vs. transudate

- Pleural fluid to serum protein more than 0.5

- Pleural fluid to serum LDH more than 0.6

- Pleural fluid LDH > 2/3normal serum LDH.

Hemorrhagic pleural effusion

- Lung ca, pulmonary infarction, TB, pneumonia, trauma.

Differential diagnosis pleural effusionVascular Pulmonary embolismInfection Pneumonia, TB, DengueTrauma HemothoraxAutoimmune SLE Metabolic Uraemia,

hypoalbuminaemiaIdiopathic SarcoidosisNeoplasm Lung ca, Meig’s

sydromeConnective tissue dz rheumatoid arthritis,

lupusDrugs Amiodarone,

Cyclophosphamide, bromocriptine

Endocrine MyxedemaOthers Fluid overload secondary

to heart, renal or liver dz.

A Lady with Underlying Chronic Renal Disease presented with Shortness of Breath

To differentiate exudates vs. transudate- Light criteria erum protein more than

Pleural fluid to serum LDH more than

Pleural fluid LDH > 2/3rd upper limit of normal serum LDH.

Lung ca, pulmonary infarction, TB, pneumonia, trauma.

Differential diagnosis pleural effusion Pulmonary embolism Pneumonia, TB, Dengue Hemothorax

Uraemia, hypoalbuminaemia Sarcoidosis Lung ca, Meig’s sydrome rheumatoid arthritis, lupus Amiodarone, Cyclophosphamide, bromocriptine Myxedema Fluid overload secondary to heart, renal or liver dz.

A Lady with Underlying Chronic Renal Disease presented with Shortness of Breath