1. Several patients presented with various respiratory complaints. Case 1 had shortness of breath and seizures, and CT showed pulmonary embolism. Case 2 had cough and shortness of breath, and CT showed bilateral bronchiectasis possibly related to allergic bronchopulmonary aspergillosis. Case 3 had abdominal distension, shortness of breath, and decreased urine output, and CT showed pulmonary embolism in a patient with known liver adenocarcinoma and ascites. Case 4 had cough and fever and CT showed a left upper lobe lesion possibly related to pulmonary tuberculosis.

1. CHEST RADIOLOGY
08-07-2022

2. CASE 1
SRIKANTH Y

3. • 33 yrs / Male
• K/C/O Hypertension since 2yrs - non complaint.
• K/C/O B/L lower limb DVT since 2yrs - not on medication.
• Ex Alcoholic and Ex Tobacco chewer- stopped 5 yrs back.

4. • Presenting complaints:-
• Shortness of breath- since 1year, grade 3 on mild activity, no postural
variation.
• Bilateral lower limb pain and swelling(Lt >Rt) since 1year- redness
present since 10 days especially in soles
• 1 episode of seizure like activity with LOC for 5 mins- tonic
movements present but no B&B incontinence, no frothing or tongue
bite on 23 of june.

5. • Past History
• H/ o similar c/o in past- 2yrs back
• Known Hypertensive since yrs not on medication.
• No h/o DM,Asthma, TB, Epilepsy, CAD, CVA, Thyroid disorder

6. • GENERAL EXAMINATION
• Patient is conscious, coherent and cooperative
• Afebrile
• BP-150/70mm of Hg
• PR- 87/min, regular, normal volume
• RR-18/min
• SP02- 98% on RA
• P- I- C- Cl- K- L- E+- B/L LL swelling pitting type, extending from ankle till
knee(Lt>Rt), Redness +, tenderness of soles+
• JVP- Not elevated

7. • SYSTEMIC EXAMINATION
• CVS- S1 AND S2 +, no murmurs
• RS - BAE + equal on both sides, No added sounds
• P/A- soft , non tender, no organomegaly
• CNS- E4 V5 M6, No FND, B/L pupils- NSRL, No meningeal/cerebellar
signs

14. CASE 2
LAXMI

15. • 40 year old female R/o Mahabubnagar farmer by occupation k/c/o Bronchial asthma since 6 yrs on rotahaler
ipratropium bromide and levosalbutamol sos now
• Presented with c/o :
1.cough since 4 days
2.shortness of breath since 3 days
HOPI :
Pt was a/a till 4 days when she developed
cough productive ,white ,mucoid ,scanty sputum,not a/w foul smell/not blood stained,not a/w diurnal variation or
positional variation, no aggravating or relieving factors.
Shortness of breath since 3 days ,(back ground h/o from 12 months) ,insidious, initially present on moderate activity
,now progressed to even at rest since yesterday,no h/o increased breathlessness on lying down position,no
aggravating or relieving factors.

16. • No h/o chest pain ,palpitations, pedal edema, decreased urine output,
• No h/o loc, syncope ,seizure like activity.
• No h/o pain abdomen ,loose stools , vomitings
past h/o:
• no h/o similar c/o in past .
• k/c/o B.ASTHMA since 6 yrs
• Not a k/c/o DM,HTN,P.Kochs, epilepsy, CVA, CAD
• Personal h/o:
• Mixed diet
• Bowel and bladder –regular
• Sleep, appetite- adequate
• Occasional toddy drinker since 10 years

17. • O/E:
• Spo2 – 80% @room air
95% @ 2 lts o2
• PR- 82/min ,regular, normal volume
• RR – 24/ min
• BP- 120/90 mm hg , lft arm supine position.
• Afebrile.
• P- I- C-C- K-L-E-
• JVP – NE
• oral cavity- normal.

18. SYSTEMIC EXAMINATION:
• R/S: BAE+ ,b/l diffuse wheeze +
• CVS: s1,s2 +
no murmur
• P/A: soft
no tender ness
BS +
• CNS: E4V5M6 ,B/L pupil NSRL, no FND.
• ABG @ presentation: ph -7.4 ,pco2 -66 ,po2 -76 , hco3 -40.9
• PROVISIONAL DIAGNOSIS: Acute exacerbation of bronchial asthma, with ? Asthma copd overlap ,with type 2
respiratory failure , with b/l diffuse bronchiectasis , to r/o ABPA in k/c/o BA.

23. APPROACH TO BRONCHIECTASIS
• 1ST Step- to detect the presence of dilated bronchus.
• Thin-section CT is more sensitive than chest radiography and is the
reference standard in identification and characterization of
bronchiectasis

24. • Next to identify type of bronchiectasis.
• Three basic morphologic types of bronchiectasis that are recognized
at CT are cylindrical, varicose, and cystic , and many patients have a
combination of these three classic types.
• Minimum intensity projection images are particularly useful for
showing winding connected tubular structures.

27. CASE OF ABPA

32. CASE 3
KALPANA

33. • 33 year old female with no prior comorbidities
now presented with
• c/o distension of abdomen since 25 days
• c/o sob since 1day
• c/o decreased urine output since 1 day

34. History of present illness
• Distension of abdomen since 25 days, insidious in onset, gradually
progressive in nature and attained to present size.
• Sob: since 1 day, sudden in onset, gradually progressive in nature to
grade ll – lll mMRC . n/a/w chestpain , orthopnea and PND.
• No h/o fever,LOA,LOW.

35. • For the above complaints patient initially went to
private hospital
• Ascitic fluid tapping done in 3 episodes
(2500,3000,1500ml)
• Usg shows mild hepatomagaly with exophytic liver
mass
• Usg guided tru-cut biopsy done from rt lobe of liver.
• Biopsy s/o adenocarcinoma with mucinous and signet
ring cells

36. Past h/o
• h/o transverse colectomy done in 2021 for polypoidal lesion in splenic
flexure, clonoscopic biopsy showing villous adenoma with high grade
dysplasia with no evidence of malignancy
• No h/o past ptb,asthma,CVA, CAD,Thyroid disorders,epilepsy.

37. • Patient came to NIMS on 23/6/22
• At the time of admission
• Pt is conscious, coherent
• Afebrile
• PR – 136 bpm
• RR -24 bpm
• Spo2 -90% at RA
• BP – 80/60 mmhg

38. • CVS - S1S2+
• RS – BAE(+)
• Decreased breath sounds on rt IMA, IAA, ISA
• P/A – distended , tense
• Fluid thrill (+), bowel sounds(+)
• Provisional diagnosis: ?Acute PTE in a known case of
Adenocarcinoma of liver with Ascites with Rt pleural effusion .

49. CASE 4
NARASSAPPA

50. • 55 year old male with no prior co morbities, chronic smoker, non
alcoholic, farmer by occupation presented with
• c/o cough with expectoration since 3 months
• c/o fever on and off since 3 months
• c/o right ankle swelling since 5 days

51. • Cough : insidious in onset, associated with Whitish Expectoration, non
foul smelling, not associated with hemoptysis.
• Fever: intermittent,associated with chills and rigor, relieved with
medication.
• Rt ankle swelling since 5 days a/w pain and erythma
• No H/o SOB/ chestpain/LOA/LOW

52. Past h/o
• No past h/o ptb, asthma, CVA, CAD, CKD, epilepsy, thyroid disorders.

53. • At the time of admission patient vitals
• Afebrile
• PR:78 bpm
• RR: 14 breaths/min
• BP:110/70 mmhg
• Spo2: 98% at RA
• CVS: S1S2+
• RS: BAE+ no added sounds
• Provisional diagnosis: COPD with LRTI? Ptb

63. Followup-case
• 43 yrs old male, with no other comorbidities, work as a borewell
drillier since 10 yrs, since 2 yrs works in making canals with h/o
increased exposure to dust, exsmoker, exalcoholic, came with c/c of
• Cough with whitish expectoration since 4 months.
• SOB since 4 months.

64. General examination
Conscious, coherent, afebrile
No pallor/cynosis/icterus/clubbing/lymphadenopathy/pedal edema
PR-87b/min
RR-30/ min
BP-120/80 mmHg
SPO2-80% @RA, 92% with NRBM with oxygen 10 l/min
Resp syst:AE+BL,b/l crepits+,b/l ronchi+
CVS- s1s2 +, no murmur
Provisional diagnosis:Occupation related pulmonary alveolar
proteinosis,D/D organising pneumonia,NSIP Pattern ILD,? Mucinous
adenocarcinoma of lung, alveolar hemorrhage.

65. 18 APRIL

66. 8 JUNE

71. THANKYOU

72. md
S.NO NAME/AGE/
SEX
INDEX HISTORY DIAGNOSIS CT/MRI NO.
1. SRIKANTH
33Y/M
6.7 C/o SOB
Seizure
PTE MDCTCT- 5019/22
2. LAXMI
40Y/F
6.2 C/O cough and SOB x 4 days b/l bronchiectasis
?ABPA
MDCT4980/22
3. KALPANA
33Y/F
6.7 K/C/O adenocarcinoma of liver with c/o
abdominal distension since 25 days
SOB and decreased Urine Output x 1 day
PTE with liver
adenocarcinoma
MDCT-7587/22
4. NARASSAPPA
55Y/M
6.2 Cough with expectoration, fever on and
off x 3 months
Left Upper lobe
fibrocavitatory
lesion ?PTB
128ct-7406/22