1. A Lady with Underlying Chronic Renal Disease presented with Shortness of Breath
Questions Notes
To differentiate exudates vs. transudate- Light criteria
transudate
1) Describe the finding in the chest x ray - Pleural fluid to serum protein more than
erum
2) What is your radiological diagnosis 0.5
3) What is your provisional and differential - Pleural fluid to serum LDH more than
diagnosis 0.6
- Pleural fluid LDH > 2/3rd upper limit of
normal serum LDH.
Answer
1) Findings on CXR Hemorrhagic pleural effusion
- Blunted of right cardiophrenic and - Lung ca, pulmonary infarction, TB,
costophrenic angle pneumonia, trauma.
- Blunted left costophrenic angle
- Trachea is not shifted Differential diagnosis pleural effusion
- Opacity at right lung field. Vascular Pulmonary embolism
Infection Pneumonia, TB, Dengue
Trauma Hemothorax
2) Bilateral pleural effusion
Autoimmune SLE
3) Diagnosis Metabolic Uraemia,
Provisional: Bilateral pleural effusion hypoalbuminaemia
secondary to fluid overload Idiopathic Sarcoidosis
Neoplasm Lung ca, Meig’s
sydrome
Differential of bilateral pleural effusion Connective tissue dz rheumatoid arthritis,
- Heart problem lupus
- Liver problem Drugs Amiodarone,
- Neurogenic APO Cyclophosphamide,
bromocriptine
- Sub arachnoid hemorrhage Endocrine Myxedema
- SIADH Others Fluid overload secondary
to heart, renal or liver dz.