What do you think, what would you do?

ultrasound to evaluate liver parenchyma and possibly shunt

CT bc shunts are more likely at this age

starting with blood work and US

US generally do not require anestesia, CT would.

All good points

two diferente things, not the same ...

If blood work what kinds?

pre/post bile acids

ct more sensitive to shunt

CT is gold standard for shunt hunts

liver enzymes may be fairly non-specific ie damage but not function. So, more Lab work Inc BA, proteins, CBC. US good for parenchyma, other viscera that may be affected by the Pathology eh endocrinopathy, shunt.

ct

quicker, easiest,

Do you all have this info for Cornell or do you need me to provide?

provide us please

not easily accessible

please send us lab contact

Will do

us

US

Depends on PE and how high. Possible watchful waiting. Repeat in 4 weeks. Trends?

us

ACTH stim or LDDS test

LDDx

Urinalysis- quali, quant and deposit.

renal panel

us and above mentioned tests

cortisol (LDST), urianalysis, CBC and biochemical profile

what if ACT Stim Test and LDDST have contraditory results?

pituitary dependente versus adrenal disease

adrenals

check the CVC during your u/s

Abd rads

xray first

xray I agree

VD view - lack of serosal detail

LL view, gastric wall increased?

I would like a left lateral if possible

big spleen? (LL view)

pancreatitis maybe US

inadequate foods (cheese, ham, etc) are the top out here. blood biochemical profile

all!!

specific PLI

depends on ultrasonographer experience

ultrasound is the more sensitve test

chest xray

FYI if you like this we can resume on another date!

yes pls!

us

CHEST XRAY + ECOCARDIOGRAPHY

XRAY FIRST

rads first to check for decompensation

for general thoracic imaging

xray first

what would menan that ondulating trachea

chest inlet trachea colapse

...I vote LAC with possible LCHF

bad positioning affets good visualization

LLsillouete poorly defined

*cardiac

leaft atrial enlargement, pulmonary edema caudo dorsal area

pulmonar edema is most probable

and bad teeth also :)

Worst mouths ever

US to check heart and for pulmonary hypertension!!

Trachea narrowed at thoracic inlet, LA enlargement poor position. Cough - CHF vs tracheal collapse.

sometimes respiarory diseases respond well to lasix

corect

*correct

Could colapse be due to cardiacdisease and chronic repiratory effort?

Any clue why diagnose was post-poned until 12 years?

Clinical/symptomatic

title :rebuttal of a rebuttal

thank you for this session. we are not so used to clinical reasoning … and it really helps. thank you

thank you!

extremely helpful!!!

awsome