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76 Years Old Have Sudden Onset Of Breathlessness. Chest X-ray Done. Diagnosis And Treatment?

Posted on Wed, 16 Jan 2013

Question: My mother 76 yrs old had a sudden onset of breathlessness c/o facial puffiness and odema. Chest PA Review findings are as under:
Peri hilar and para cardiac haziness is seen on both sides;
CT ratio is disturbed;
Unfolding of aorta seen;
Bilateral pulmonary hila appear enlarged;
Bilateral CP angles are clear;
Trachea appear normal;
Bony thoracic cage is normal.
Total Hemogram revealed increased ESR - 45 mm/ist hr
Neutrophiles 89%
Lymphocyte 09%
KFT TEST - All normal
Blood Glucose Random - 160 mg/dl
What are the diagnosis and treatment in such cases.

XXXXXXX

Answered by Dr. Mayank Bhargava (1 hour later)

Hi XXXXXXX,
Welcome to XXXXXXX forum.

Let me explain other associated symptoms along with breathlessness.
Does she has breathlessness exacerbation on lying down/ fever/ chest pain?
Does she has pedal edema also?
What was the finding of electrocardiograph (ECG)?

Sudden onset of breathlessness with facial puffiness and edema along with chest x XXXXXXX finding suggests Congestive heart failure.
Presence of normal renal function test suggests the diagnosis.
Parahilar and paracardiac haziness may be due to pulmonary edema.
Unfolding of aorta is radiological abnormality on chest X-ray that show widening of the mediastinum which might look like thoracic aortic aneurysm. It is not a serious problem.
Rest of chest X XXXXXXX findings appears to be normal.

Complete hemogram is normal with normal differential leukocyte count (DLC).
ESR is raised and suggestive of some sort of active disease if going on in body.
Blood sugar random 160 mg% is also normal and diabetes is labeled when fasting Blood sugar > 126 mg% and postprandial blood sugar is > 200 mg%.

I am not able to open the attached reports.
As such there appears to no correlation between present symptoms and past history of joint ache and use of paracetamol & ibuprofen.
Presently prescribed medicines are for relief of edema, cough along with correction of any sort of infection.
This can be only judged by examination and you should keep in touch with your family physician.
She should also go for ECG, 2 D echo, BNP (brain natriuretic peptide) and Treadmeal test (only after relief of symptoms and well being feeling).

So with current investigations status and clinical findings, Congestive heart failure appears to be disease process.
She should take prescribed medicines and should go for investigations later on.
Hope that helps.
Let me know if I can address any more concerns.
Take care,
Dr. Mayank Bhargava

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Mayank Bhargava (2 hours later)

Her weight must be around 90 Kg and height of around 5ft 2 inches, walks with difficulty due to knee problem. Her BP, in general ranges - Systolic 180/Diastolic 100 and has not been taking any medicine for BP in the past. ECG is normal. SHE DOES NOT HAVE FEVER. 10 days ago she had a very bad cough and no medication was taken by her. Cough became alright since last 1 week but has suddenly developed current condition. She has been prescribed Novomox 650mg bd and Levoflox OD and olmighty-H OD, Lasix 20 mg OD,Brozedex Syrup 10ml tds. She developed puffiness of whole face with eyes bulging out and pedal oedema which after 2 days of above medication has become normal. Breathlessness is lesser now. Her ESR being high for the last 4-5 years, a bone marrow tissue culture test was done 4-5 yrs ago with no infection detected at that time. Since she is a bit better with the medication should we wait for 5 days medicine course to be completed for further investigation or is it advisable to admit her right now and as her breathlessness improves a bit then we go for Echo, etc as suggested.

Answered by Dr. Mayank Bhargava (26 minutes later)

Hi XXXXXXX,
Her BMI (basal metabolic rate) is 36.58 and she should be categorized as obese.
Her condition improved yet now with improvement in all symptoms.
She should continue the same medication for further relief and She should go for prescribed investigations only after 5 days.
She should also continue Olmighty-H for control of blood pressure.
She may need diuretics in future for prevention of edema.
ESR is a non specific investigation and it generally indicates a disease process is going on.
Best regards,
Dr. Mayank Bhargava

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar