14 Yr old male with marfanoid habitus.
INTERNS
Supriya
Sanjay
Amrutha
Mohitha
Sowmya
Dr Durga Krishna pgy1
Dr Ajith Kumar pgy2
Dr Laxma Reddy pgy3
Dr Manasa pgy3
Dr Vijayalakshmi Ast.prof.
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A 14 yr old male from Mothkur, currently in his 9th standard of schooling, presented with c/o chest pain for 2 days, 5 days ago.
The patient was apparently asymptomatic 3 yrs ago. From his 7th standard, whenever he was made to run in his sports class, he would have shortness of breath after running around 50 metres. He could not perform as well as his peers. He would still continue to run as he would be punished and made to run more if he stopped. He somehow made sure that he would finish the race.
He complains of blurring of vision when he tries to focus on something for too long, in his classes and while studying. No h/o diplopia.
He says he has palpitations often when talking to people.
A year ago, he noticed a swelling on the left side of his upper chest which gradually increased in size over 2 months for which he went to a private hospital. There was no history of trauma. His regular blood work up was done and they told him he had less blood(reduced hemoglobin levels) and had 2 blood transfusions.
He has been staying in a hostel from his 6th standard and he says that they provide good food with both vegetarian and non vegetarian diet and he eats well.
After his blood transfusions he stopped running during his sports classes as the doctor advised him to do so.
He was fine for the last 1 year.
5 days ago he had chest pain for 2 days which was on the left side, diffuse, pricking type, non radiating, continuous, no aggravating factors, relieved on its own after 2 days.
No h/o orthopnea, PND.
Past history:
Not a k/c/o hypertension, diabetes mellitus, TB, Epilepsy, Bronchial Asthma, CVD, thyroid disorders.
H/o 2 blood transfusions 1 year ago.
No h/o surgeries.
Personal history:
Good appetite.
Mixed diet.
Sleep adequate.
Regular bowel and bladder movements.
He has toddy once in 2 months or so.
O/E-
Patient is conscious, coherent, cooperative, oriented to time, place, person.
No pallor, icterus, cyanosis, clubbing, koilonychia, pedal edema, generalised lymphadenopathy.
Arm span- 178 cms
Height- 168 cms
VITALS:
Afebrile.
BP-120/80 mmhg
PR- 67 bpm
RR- 20 cpm
SpO2- 98%
SYSTEMIC EXAMINATION:
RS-
-Swelling at the medial end of left clavicle.
-BLAE+
-NVBS+
CVS-
-Apical impulse is felt in the left 5th intercostal space, medial to mid clavicular line.
-S1S2 heard.
-Apex beat heard in the left 5th intercostal space, medial to mid clavicular line.
-No murmurs heard.
P/A-
-Soft, non tender.
-No organomegaly.
-Bowel sounds heard.
CNS- NAD.
INVESTIGATIONS:
DIAGNOSIS:
Marfanoid habitus.
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