A mother brings her 8 years old child with history of chronic cough , about one year , the cough has become worst in recent days and associated with haemoptysis and chest pain ,fever ,vomiting and no history of weight loss. Admission to PICU Elkhadra Hospital: On examination : Temp 39.7Ć. R/R 66. H/R 150. Spo2 in room air 92%. Capillary perfusion 2 sec. Chest : ICR SCR SSR (muscle retraction) Marked decrease air entry in upper and middle left side Tenderness over the chest. Cardiovascular : S1 S2 tachycardia CNS: GCS 15 -ve meningeal sings good tone +ve deep reflexes. Normal eyes movement Abdomen : soft lax Investigations;- CBC : Eosinophilia , rising CRP and ESR viral screen -ve . ABG : acute respiratory alkalosis Chest x ray : we discover round irregular pulmonary mass. U/S chest showed large cystic mass in the upper left lob, whit pleural effusion. ECHO revealed that heart and large vessels pushed to right side. Pleural tab was done(aspirated about 10 cc) and Send to biochemistry (sugar, protein, LDH, cells ) plus gram stain and culture. Immediately we started empirically antibiotics(Meropenam and clindamycin). The child have been several times toTrhona city where prevalence of hydrated disease is very high> Pleural aspirated fluid showing high protein high Normal sugar and LDH (EXUDATE) .The diagnosis was made by CT ,MRI : showing large cyst (80 Cm) full fluid and the scolices inside.) We start albendazo 4 days before surgical intervention.(cystectomy , followed by installation of scolicidal agent ) and continues albendazol after operation KEY POINTS : Source of infection faces from infected dogs Chest pain / cough / haemoptysis clinical signs for pulmonary hydatid cyst. Treatment dependent on location / size . Thank u Posted by Dr Mohammed Eezziady Write a reply...
Posted on: Wed, 24 Dec 2014 09:24:17 +0000
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