14Y/M.

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Here we discuss our individual patient problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs

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CASE :

A 14yr old male, who is a student resident of Nalgonda came with chief complaints of

. Fever since 8 days

. Cough since 8 days

. Shortness of breath since 8 days. 

History of present illness :

The patient was apparently asymptomatic 8 days ago, then

. He developed fever, which was insidious in onset, low grade, continous, associated with chills and rigor and relieved on medication. 

. He developed cough, which was insidious in onset, not associated with expectoration and no aggravating and relieving factors. 

. History of shortness of breath, which is insidious in onset, progressed from grade 1 to grade 2 (according to MRMC), aggravated on exertion and relieved on sitting position. 

RESPIRATORY SYSTEM EXAMINATION :

INSPECTION - 

. Trachea central

. Expansion of chest decreased on left side. 

PALPATION -

. Trachea central in position 

. Expansion of chest decreased on left side

PERCUSSION :

. Dull note on left interscapular area, infrascapular area and infra axillary area. 

AUSCULTATION :

. Decreased breath sounds on left side. 

. Diminished vocal resonance in left infrascapular area, infra axillary area interscapular area. 

INVESTIGATIONS : 

Chest X-ray 

Pleural fluid analysis

Light's criteria

Pleural biopsy 

Pleural tumor markers ( CEA, CA-125) 

Blood and sputum examination 

PROVISIONAL DIAGNOSIS :

Left sided pleural effusion.