August 2, 2013

Acute Bronchiolitis with Underlying Complex Cyanotic Heart Disease

This is chest X ray of a 3 months old baby boy who presented with history of rapid breathing for 2 day duration associated with URTI symptoms.

On examination, patient is tachypnoeic with respiratory rate of 60, central cyanosis, nasal blockage and SPO2 of 90% under room air. otherwise, non septic looking and active. cardiovascular examination reveals palpable apex beat at right chest region, pan systolic murmur grade 3. Lung examination reveals good and equal air entry bilaterally with transmitted sound. Expiratory phase is prolong. No crepitation or rhonci noted.

Chest X ray shows hyper inflated lung with perihilar haziness and dextrocardia. A diagnosis of acute bronchiolitis with underlying cyanotic congenital heart disease (not in failure) was made.

Prior to that, at three weeks of life, he presented with cough, fever and bluish discoloration of body and treated with bronchopneumonia with underlying heart problem.

one month earlier, he presented with unprovoked cyanotic spell.

ECHO was done and noted finding of complex cyanotic heart disease consisting of situs solitus dextrocardia, large muscular apical ventricular septal defect, double outlet right ventricle, transposition of great arteries and pulmonary stenosis

More on Dextrocardia:

Image of the Day 11: The Missing Heartbeat [Link]

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