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Breathing difficulty after a fall with chest pain. Why bouts of vomiting?

My son, 11 yrs. age, had an accidental fall from a local ricksaw chest downward 3 months back. X-ray was negative and showed no clue though he complained of breathing , chest pain and right upper abdominal(below chest) pain. Then after medication he felt okay and went to school regularly. Before 2 weeks from now he started having fever and nausea which prompted him to eat less and he lost 5 - 6 Kilograms of wieght. Local Paeditrician suggested blood tests, USG and Digital X-ray. USG report showed right side mild pleural effusion however, the X-ray report was negative and blood reports ok. We again went for X-ray two days later which reflected plural effusion on left side (mild). This made us to admit him in local hospital at Kolkata which went for tapping and 350 ml fluid extracted USG guided. Fluid culture had shown no malignant cell and all was negative. After tapping he had fever every 8 -10 hours with vomitting. Then we again took him to APOLLO CHILD at Chennai after one week from tapping. They did 320 slice CT scan showing some cocks (less than 1 cm) towards inside of pleural membrane. USG done again showing insufficient fluid to be tapped for culture again. Reknowned Paediatrician has started medication (T.AKT-2, T.P-zIDE-750mg, T.Albutul-800mg and T.Bendon) and Tab DOLO-650 for fever. Fever repeats after every 10-12 hours with bouts of vomitting. Though no clear evidence of Tuberculosis is there the above medication is going to help me or not. I am in a dilema. Please help me out if you can Sir. Abhijit
Asked On : Fri, 28 Sep 2012
Answers:  1 Views:  174
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Internal Medicine Specialist 's  Response
Dear friend, welcome to HCM!

Your child had a clear post-traumatic pleural effusion- ususally a bloody one called Haemothorax.
If it was not bloody, it is still a likely late effusion.
It is likely infected and hence the fever and vomitting. Surprisingly culture failed to show any growth- which is possible and not rare.
Starting anti TB treatment seems unreasonable here and you should take second opinion.
We do not start ATT without demonstrating tuberculosis evidence.
And yours is a case of post traumatic effusion or and empyema.
Try consulting a pulmonologist also and keep him on antibiotic cover. Please get a complete blood work done.
It could turn serious unless treated appropriately. TB is a rare possibility in this situation.

Take care and please keep me informed of your progress.
Good Luck!
I hope to have answered your query satisfactorily.
Thank you!
Answered: Fri, 28 Sep 2012
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