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Medical Student Forums => Problem-Based Learning Center => Topic started by: Diagnostic on December 03, 2007, 03:25:46 AM

Title: X-ray Case (1)
Post by: Diagnostic on December 03, 2007, 03:25:46 AM
(http://myweb.lsbu.ac.uk/dirt/museum/margaret/63--2083a-3161420.jpg)We need different ways of group studying in this site, so that everyone can participate and get benefits, X-ray cases are interesting to every practioner and it's helpful mthod during diagnosis.
I have a good collection of different X-rays and I would like to post it as cases, if you have any comments or suggestions feel free to contact me.
Thanks
Case:
A 48-year old female from Iceland presented with hemoptysis preceeded by chronic cough for 3 months & pleuretic chest pain.
On Examination: the patient was jaundiced, with mild fever, decreased breath sounds in RT side of the lung, the liver is enlarged 3 cm below the costal margin & tender.
Basic routine investigations shows leukocytosis with marked increase in eosinophils.
CXR shows mass lesion with good margin in the right lower zone.

Questions:

1- What is your diagnosis? (look at the X-ray)
2- If that mass go into changes, what do you call that change & the sign that will appear?!
3- Mention other sites this mass can appear?
4- What is the worst complication can happen to this patient?
5- What is the treatment?
Diagnostic
Title: Re: X-ray Case - 1
Post by: Kassim on December 03, 2007, 05:30:39 AM
1- What is your diagnosis? (look at the X-ray)

 i think it is Echinococcus granulosus, also known as hydatid disease

2- If that mass go into changes, what do you call that change & the sign that will appear?!

hydatid cysts. The sign will depend on the particular organ that are affected, e.g. in the brain hydatid cyst will present as a space-occupying lesion.  If the diaphragm is involved the patient presents with clinical picture simulating pleurisy.

3-Mention other sites this mass can appear?

Kidney, CNS,  Spleen, heart, abdominal cavity,  the diaphragm, and can affect any organ in the body

4-What is the worst complication can happen to this patient?[/b]

The cyst my rupture and lead Systemic anaphylaxis.
Other complication includes: Vena cava obstruction, Small bowel obstruction, Gastric perforation, Pulmonary embolism, Focal cerebral disorders (eg, seizures, hemiparesis, aphasia), cardiac tamponade

5- What is the treatment?
Albendazole 400mg BD before and continue for 28 days after the drainage.
surgical intervention if needed.
 
hope this is right answer


Hope this is right answer   
Title: Re: X-ray Case - 1
Post by: Diagnostic on December 03, 2007, 07:16:44 PM
Well done
your answer is correct although in question "2":
The mass may repture forming what is called "Water lilly sign" that may appear in the X-ray.
Diagnostic
Title: Re: X-ray Case - 1
Post by: Admin on December 03, 2007, 08:11:32 PM
Congratulations
the 15 points of this case goes to Kassim
Dr.Mahdi