Get your health question answered instantly from our pool of 18000+ doctors from over 80 specialties
150 Doctors Online

By proceeding, I accept the Terms and Conditions

Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

HCM Blog Instant Access to Doctors
HCM BlogQuestions Answered
HCM Blog Satisfaction

76 years old have sudden onset of breathlessness. Chest x-ray done. Diagnosis and treatment?

Answered by
Dr.
Dr. Mayank Bhargava

Internal Medicine Specialist

Practicing since :2003

Answered : 1658 Questions

default
Posted on Wed, 16 Jan 2013 in Hypertension and Heart Disease
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
doctor
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
doctor
default
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.
doctor
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
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
premium_optimized

The User accepted the expert's answer

Share on
Question is related to
Diseases and Conditions ,   ,   ,   ,   ,  
Drug/Medication ,  
Lab Tests
Medical Topics

Recent questions on  Lasix

doctor1 MD

i am 72 yrs old and suffring from paralisis in right side since last 7 year ago .dr. advice to me on 4-1-2012 after addmite in his hospitl 5 days...

doctor1 MD

my husband is taking Isosobide mn 30 mg he has an defib implant his Bp has been going very high even after the Doc increased his Lisinopril to 40...

doctor1 MD

Hi there, I am an nursing student working as an ESN (Employed Student Nurse) in an acute medical unit. Today I worked with a pt who was 78yrs old...

doctor1 MD

My father is 71 years old, post colon cancer pt, (6 yrs clear), had knee surgery a few years ago; skin on both legs is shiny , mostly hairless...

doctor1 MD

I'm a 30 year old female with no prior health problems. For the last year or so I have had bouts or severe pitting edema in my legs and feet to the...

doctor1 MD

I have diabetes cholesterol and digestive problems My diabetes fluctuates many times high to low low to high. I go for motions 4 to 5 times a day....

doctor1 MD

I want to go for LASIK surgery, Could you please advise on how to choose and decide on same. What are the negatives of this surgery. Or is there...