Discussion in 'Spot Diagnosis' started by Johnald, Apr 7, 2013.
Raised lt. hemidiaphragn
1) traumatic rupture
2) phrenic nerve paralysis
3) scar contracture pulling the diaphragm up ( post tubercular complication )
Left diaphragmatic rupture
Elevation of left hemidiaphragma is present.Gastric air bubble is not seen.Contour of hemidiaphragm is regular.
I think first diagnosis should be subdiaphragmatic mass such as colonic neoplasma,abscess formation or splenomegaly .
second diagnosis is phrenic nerve paralysis.
In differential hernia hiatus.
Had a re-look at the Xray....
so, i guess this may be an Xray chest of a old case of tb with possible reactivation esp. becos both upper zones, show some infiltrate and in the light of the suspected subpulmonic effusion. I can see some fine miliary scattering as well....in short the case needs to be thoroughly investigated and a "Quantiferon Gold Test" ( not mantoux), if available shud be sought 4 in addition to the other investigations.
Hope Johnald, throws further light on the Xray (-:
Thank you very much
U r welcome, but what is the answer ?
This was a case of an alcoholic and smoker 89 years old man with a laryngeal squamous cell carcinoma causing a left phrenic nerve paralysis
thanks 4 sharing the case and furthering the message - "Cigarette Smoking & Drinking is Injurious to Health".
P.S: He may have had TB as well in the past, considering his social habits.
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