Case Presentation (two cases)

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Case No 3 : 

Case No 3

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Personal history 37 years old, female patient. House-wife, lives in El-Sayeda Zeinab. No special habits of medical importance.

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Lt. sided chest pain of one month’s duration of gradual onset and progressive course. Presentation

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Present history Generalized colicky abdominal pain, not referred or radiated, responds to antispasmodics of mild severity of one month’s duration. Cough and expectoration of blood-tinged sputum for few days, one month ago. Left sided mammary and inframammary stitching pleuritic chest pain not radiating or referred of moderate severity of one month’s duration.

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Past history: Irrelevant Family history: Irrelevant Menstrual history Age of menarche 13 yrs. D/C: 5/28. No bleeding. No irregularities.

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General examination Heart rate 86/m regular, equal, of average volume, peripheral pulsations are well felt. Bl. Pr. 120/80. Temp 36.9°C. No LL edema. Lax calf muscles. No clubbing No clinically palpable LNS. No congested neck veins. Breast examination showed no abnormality. Local examination RR: 20/m,regular, abdomeno thoracic. No abnormality detected in chest examination.

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1- What is the most probable provisional diagnosis? P.E 1 2 Lung cancer. 3 Pulmonary T.B. 4 Collagen disease.

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Chest X-ray was done showing.

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ESR: 60 mm/hr. Routine lab investigations: All within normal range except:

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2- What is the most important investigation to be done? 1 F.O.B Sputum for ZN Stain 3 C.T scan chest 2 4 V/Q scan.

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C.T chest was done on 24/5/2003:

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3- What is the next investigation to be done? 1- Pulmonary angiography. 2- C.T guided biopsy. 3- Hydatid titre. 4- F.O.B. 5- Abdominal U/S.

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IHA test for hydatid disease was done on 11/6/2003 and showed: Hydatid disease of the lung 1/640 and the normal range is up to 1/80 = +ve titre

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4- What is the most probable management? 1- Medical treatment. 2- Surgery. 3- Observation. 4- Surgery + Medical treatment.

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The patient underwent an operation for excision of the hydatid cyst under cover of medical treatment in the form of :Albendazole (Alzental) 200mg tab2x2 for 4 wks followed by 2wks drug free period for 3 cycles

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Hydatid cyst picture

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Post -operative C.T chest:

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Post -operative hydatid titre: 1/80 = Negative titre.

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Case No. 4:

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C/O:A single female patient aged 20 years old complaning of shortness of breath, easy fatigue, chest pain, fever.

Present history:The condtion started 4 months ago with gradual onset of dyspnea, progressive course She received non specific medical treatment as NSAID with no response Her doctor advised her to do ECHO which showed mild pericardial effusion He refered her to our hospital with pericardial effusion ,pallor ,dyspnea : 

Present history:The condtion started 4 months ago with gradual onset of dyspnea, progressive course She received non specific medical treatment as NSAID with no response Her doctor advised her to do ECHO which showed mild pericardial effusion He refered her to our hospital with pericardial effusion ,pallor ,dyspnea

Examinaton :-pallor-dullness ,decrease intensity of breath sound on left side of the chest : 

Examinaton :-pallor-dullness ,decrease intensity of breath sound on left side of the chest

Investigation :-CXR:left pleural effusion ,pericardial effusion-Aspiration of 1500cc of pleural fluid and cytological examination showed Inflammatory smear ??TB-other investigation are normal apart from anaemia(HB 8 gm) : 

Investigation :-CXR:left pleural effusion ,pericardial effusion-Aspiration of 1500cc of pleural fluid and cytological examination showed Inflammatory smear ??TB-other investigation are normal apart from anaemia(HB 8 gm)

Treatment:--The patient received anti TB drugs :INH, RIF, PZ,STPredilon 20 mg /day -Transfusion of 500cc fresh blood : 

Treatment:--The patient received anti TB drugs :INH, RIF, PZ,STPredilon 20 mg /day -Transfusion of 500cc fresh blood

After 2 Ws dyspnea disappear , general condition is improved : 

After 2 Ws dyspnea disappear , general condition is improved

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Aspiration of 1000cc from Rt side for chemical &cytological examination : -ADA: -ve Rh factor -ve- -Anti ds DNA +ve ANA +ve-

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Anti TB was stopped Prednisolone is continued

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The patient advised to consult Rheumatologist who continue predilon plus Cyclophosphamide

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Pulmonary manifestation of SLE Shotness of breath or dyspnea may be due to many causes :- -Pulmonary effusion due to serositis -Pulmonary embolism -Lupus pneumonitis -Chronic interstitial lung disease -Pulmonary HTN due to vasculitis

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Thank you

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