A 65 YEAR OLD FEMALE WITH BILATERAL PEDAL EDEMA AND SHORTNESS OF BREATH

SHORT CASE

HALL TICKET NO. 1601006149

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A 65 YEAR OLD WOMAN WITH BILATERAL PEDAL EDEMA AND SHORTNESS OF BREATH

A 65 year old female from Alingapuram came to the hospital 25 days back with complaints of fever & swelling in bilateral lower limbs since 1 week and shortness of breath since 4 days. 

HISTORY OF PRESENT ILLNESS:

The patient was apparently asymptomatic 25 days ago then she developed:

- Swelling in the legs which started bilaterally in the feet and gradually progressed up to mid calf level. 

- Shortness of breath while sitting which was insidious in onset, gradually progressive. 

- Associated with cough, and fever which is of low grade and continuous type. 

- No history of chest pain, palpitations, decreased urine output, blood in urine, burning micturition

PAST HISTORY:

- No history of similar complaints in the past.

- Patient is a known case of Hypertension since 2 years for which she took medication irregularly. 

- Not a known case of Diabetes Mellitus, Asthma, TB, Epilepsy 

- History of bilateral knee pain since 1 year for which she was prescribed pain killers- NSAIDS

- No significant surgical history.

PHYSICAL EXAMINATION (AFTER TAKING PATIENT'S INFORMED CONSENT) 

GENERAL EXAMINATION: 

- The patient is conscious, coherent, not co operative. Moderately built, moderately nourished.

- She has pallor. 

- She has edema- pitting type (involving both feet and legs upto mid calf). 

- No sign of Icterus, cyanosis, clubbing, cyanosis, koilonychia, lymphadenopathy. 

Vitals:

- Patient is afebrile.

- Pulse Rate: 82 beats/minute.

- Blood pressure: 130/80 mm Hg. 

- Respiratory rate: 20 cycles/minute.

- Spo2: 98%

SYSTEMIC EXAMINATION:

RESPIRATORY SYSTEM:

- Shape of chest is normal. 

- On inspection of upper respiratory system, oral cavity, nose, pharynx are normal. 

Lower Respiratory Tract:

- On Inspection, chest is symmetrical, trachea is central and bilateral symmetrical expansion of chest with respiration. 

- No scars, engorged veins or sinuses. 

 

- On palpation, inspection findings are confirmed. 

- Trachea is central- confirmed by three finger test. 

- Bilateral symmetrical expansion of chest.

- No chest wall tenderness. 

- Vocal fremitus- decreased in inframammary, infraaxillary and infrascapular areas. 

- On percussion, done in sitting position, stony dullness is noticed in inframammary and infrascapular areas. 

- On auscultation, vesicular breath sounds are diminished in infra mammary, infraaxillary and infrascapular areas. 

- Vocal resonance- markedly diminished over the fluid area. 

- Basal crackles are present.

CVS, Abdomen and CNS are normal. 

INVESTIGATIONS:

COMPLETE BLOOD PICTURE:

- Hb- 6.2g/dl

COMPLETE URINE EXAMINATION:

- Albumin: +2

LIVER FUNCTION TESTS:

RENAL FUNCTION TESTS:

- UREA- 94 mg/dl

- CREATININE: 6.3 mg/dl

- URIC ACID- 9.9 mg/dl

X-RAY:

ULTRASOUND:

- Few subcentrimetric anechoic cysts in bilateral kidneys

- Right Kidney- CMD lost (Grade 3 RPD) 

- Left Kidney- CMD partially maintained (Grade 2 RPD) 

- Patient underwent 6 sessions of dialysis since admission. 

PROVISIONAL DIAGNOSIS:

- Renal failure with bilateral Pleural Effusion.