CXR: Multiple calcifications
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A 55-year-old man from Rajasthan presents with a history of recurrent respiratory infections. Chest X-ray shows multiple soft tissue calcifications and healed parenchymal lesions. Soft tissue calcification can be caused by dystrophic calcification in damaged or diseased tissue. The patient's chest X-ray findings and history of recurrent respiratory infections suggest previous tuberculosis infection. Soft tissue calcification seen in this case is likely due to healed lesions from prior pulmonary tuberculosis.
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This document summarizes the case of a 20-year-old man admitted with jaundice. He had ingested rodenticide poison containing yellow phosphorus four days prior. Initially his condition was managed conservatively, but his jaundice progressively worsened. He was referred for possible liver transplantation. Testing showed acute liver failure likely due to the toxic effects of yellow phosphorus poisoning. He received supportive care including dextrose, vitamin K, and plasma transfusions. His condition was stabilized with medical management.
A Case of Emphysematous Pylonephritis
A 50-year-old lady presented with shortness of breath, fever, cough with sputum production, and swelling of both legs over the past two days. She has a history of type 2 diabetes and hypertension. Examination found decreased breath sounds and mild dehydration. Investigations showed diabetic ketoacidosis, urinary tract infection with E. coli growth, and cirrhosis of the liver. She was diagnosed with type 2 diabetes, hypertension, emphysematous pyelonephritis, and transferred to urology for further management.
Imaging: Multiple Pulmonary Cavitary Lesions
A 38-year-old male smoker presented with swelling all over the body for the past 4 months. Examination revealed pitting pedal edema. Investigations showed elevated ESR, CRP and P-ANCA positivity. CT scan showed multiple cavitary lung lesions. A diagnosis of Wegener's granulomatosis was made based on clinical features, lab investigations and radiological findings.
ECG: Atrial Dissociation
This ECG shows atrial dissociation in a 70-year-old male with a history of hypertension, coronary artery disease, and cardiac transplantation 6 months prior. Atrial dissociation is seen as two independent sets of P waves with varying PP and PR intervals. Atrial dissociation occurs when each atrium beats separately due to blockage of the Bachmann's bundle interatrial pathway. It can occur in orthotopic and heterotopic heart transplant patients as the posterior atrial wall is retained but denervated after orthotopic transplant.
A Case of Hepato-Pulmonary Syndrome
This case involves a 35-year-old female with a history of non-cirrhotic portal fibrosis, splenectomy, recurrent tuberculosis, and recurrent bouts of hematemesis and fever. She presents with cyanosis, clubbing, and shortness of breath. Testing reveals findings consistent with hepatopulmonary syndrome, including low oxygen saturation that decreases further in an upright position. A contrast echocardiogram confirms intrapulmonary vascular dilations. She is diagnosed with severe, longstanding hepatopulmonary syndrome secondary to non-cirrhotic portal hypertension.
A Case of Thalassemia
A 25-year-old male presented with a history of anemia since childhood. Examination found pallor and hepatosplenomegaly. Investigations revealed microcytic hypochromic anemia and bone marrow aspiration showed erythroid hyperplasia consistent with thalassemia intermedia. Patients with thalassemia intermedia have variable clinical presentations between thalassemia major and minor, and may require lifelong monitoring and chelation therapy to manage iron overload from ineffective erythropoiesis.
A Case of Renal Amyloidosis
The document summarizes the case of a 60-year-old male admitted with generalized swelling of the body for 20 days. Investigations revealed IgA monoclonal gammopathy and renal biopsy showed features of amyloidosis. The patient was diagnosed with primary amyloidosis (AL type) associated with hepatitis B infection. Treatment with diuretics and antibiotics improved his symptoms and kidney function recovered.
CXR: Silico-Tuberculosis
A 52-year-old female patient presented with complaints of breathlessness and dry cough for the past 6 months. She has a history of treated pulmonary tuberculosis 3 years ago and treated Pott's spine 2 years ago. Examination revealed wheezing and generalized pigmentation. Chest X-ray showed bilateral lung parenchymal lesions and hilar lymph node calcifications. The final diagnosis was occupational lung disease of silicosis complicated by silicotuberculosis due to exposure to silica particles in her work in sand filtration for brick production.
ECG: A Case of Flutter-Fibrillation
A 70-year-old woman presented with chest pain and palpitations. Her ECG showed atrial flutter with an atrial rate of 340 beats per minute and ventricular rate of 60 beats per minute. The morphology of the flutter waves indicated clockwise conduction around the left atrial circuit, consistent with type I atrial flutter. Treatment options for atrial flutter aim to control the ventricular rate, restore normal sinus rhythm, prevent recurrence, and minimize thromboembolic risk. Catheter ablation can eliminate the reentrant circuit causing atrial flutter.
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