A 60 year old male patient presented with hoarseness of voice lasting for 2 months. First he was examined by the otorhinolaryngologist of our hospital, who noticed absence of movements of the left vocal cord. Chest X-ray showed a large opacity in the left upper zone and the patient was referred to the pulmonologist. His general physical examination was unremarkable not having any stigmata of Marfan's or Ehler Danlos syndrome. On chest auscultation, a systolic flow murmur was audible and there was decreased breath sound in the left infraclavicular area. Bronchoscopy revealed absence of movement of left vocal cord. His trans-thoracic echocardiography revealed degenerative aortic and mitral valve disease with mild aortic regurgitation and mild mitral regurgitation with dilated aortic aneurysm. A contrast enhanced CT scan of thorax and CT Angio Aortogram revealed fusiform aneurysmal dilatation of the arch of aorta with diameter of 6.2 cm over a length of 12.3 cm showing intraluminal partial thrombus with wall calcification. The patient was advised to undergo surgery. However, after detailed discussion with him and his family, they decided for medical management in view of his advanced age.

BACKGROUNDEmpyema Thoracis (ET), the accumulation of pus in pleural cavity due to infective origin, is a perpetual clinical entity since Hippocratic era. The incidence and prevalence varies depending on different countries, type of infections, age and immune status of the host.

Background: Diagnosis of cervical tuberculous lymphadenitis has been challenging to clinicians as it mimics multiple diseases. USG has upper hand over other diagnostic modalities as it is non- invasive, low cost, time saving and guided procedures like FNAC and core needle biopsy can be performed. Methods: This is a prospective observational study conducted in 100 patients from June 2019 to May 2020 in Dept of Pulmonary medicine, PRM Medical College and Hospital, Baripada. A complete clinical examination, routine blood investigations, CXR, USG Neck, FNAC and CBNAAT were done and data was recorded. Results: Maximum numbers of patients were in age group of 11-20 years (38%) followed by 21-30 years (32%) and presented between the duration of 1-3 months. There were 44(44%) males and 56(56%) females; male to female ratio was 1:1.3. Most of the patients (70%) did not have any constitutional symptoms and maximum number of patients i.e. 53% had matting of LN followed by discrete node 29% whereas 10% patients presented with abscess and 8% had discharging sinuses. In USG, 46 (46%) showed cervical lymphadenopathy with tubercular aetiology with sensitivity and specificity of 90% and 50% respectively with accuracy of 88%.

Aim and Introduction:  To determine the association between Coronary atherosclerosis in Chronic Obstructive Pulmonary Disease and Carotid Artery Intima Media Thickness. The objective of the present case control study is to determine the association between carotid atherosclerosis in COPD patients and cardiovascular morbidity. Material and methods. It was a prospective case-control observational study. 50 COPD patients and 50 age- and gender-matched non-COPD controls were studied. Carotid artery USG scanning was carried out using B-mode duplex USG for measurement of carotid artery intima - media thickness. Results. CIMT was found to be more common in COPD group patients (78%) as compared to non-COPD group patients (26%) (P value = 0.000). The mean CIMT is 1.04 0.41 mm in the COPD group and 0.71 0.24 in the COPD group with a P value of 0.0001. The mean CIMT in Gold 3 was the highest (1.10 0.48 mm), followed by Gold 4 (1.05 0.46 mm) and the minimum in Gold 1 (0.73 0.00 mm). Conclusion. Our study shows that COPD is associated with increased CIMT, which is a preclinical predictor of coronary atherosclerosis and cardiovascular risk. However, further studies are needed.

Pulmonary Alveolar Microlithiasis (PAM) is a very rare diffuse lung disease, affecting both lungs by intra-alveolar deposition of calcium phosphates in form of microliths. There have been about 700 cases of PAM recorded in the medical literature. The etiopathogenesis of the disease is unknown. It is now thought to be an autosomal recessive disease caused by deletion of Na-Pi cotransporter (Npt2b) in alveolar epithelial cells due to defective DNA mutation in the gene SLC34A2. The disease is slowly progressive, usually detected in 3 rd /4 th decades of life and death is due to cardiorespiratory failure. The patients detected with PAM in pregnancy are exceptional. Very few cases were reported till date. We report a pregnant lady presenting with PAM delivering vaginally a healthy female child in spite of cardiomegally and severe PAH.