A middle-aged obese man was referred to me for an emergency echocardiography
The patient was unable to lie either supine or left lateral . He could lie down only right lateral posture that too for a minute .An ultra fast echo gram was completed . It was entirely normal . His ECG was also normal.
When I asked for x ray there was a surprise
Note the shrunken thoracic space on both sides .The fundus of stomach is almost fighting for place with left ventricle in the thoracic cavity .
No wonder he is severely orthopnic (But fairly comfortable on erect posture )
He has a distended abdomen .He is now waiting for a GE consult. His other complaint is belching . Is that some form of gastric obstruction ?
I’m posting this image to re-emphasise the classical teachings in medicine .
Human body is a highly integrated biological system .We in the name of modern science has disintegrated in to multi organ entity.
This patient was labeled as acute pulmonary edema and the treatment was about to be started.
Here is a patient with dyspnea and orthopnea entirely due to a non-pulmonary and non- cardiac cause !
All youngsters . . . always be alert . Clinical medicine is notorious for throwing surprises , especially when you least expect it !
Dr.S.Venkatesan MD 