DIAGNOSTIC PROCEDURE XRAY: Chest / Right Lateral Decubitus Interpretation: No previous film available for comparison.

Hazy densities are seen in bilateral lower lobes and right upper lobe probably due to bibasal pneumonia and PTB respectively. The right costophrenic angel is blunted in the PA view. Complimentary lateral decubitus view shows layering of hazy densities in the dependent portion at the right hemithorax for which pleural effusion is considered. The rest of the lung fields are clear. The heart is not enlarged. The aorta is atheromatous. Other chest structures are not remarkable. Date: 29- JULY- 2011

XRAY: Chest PA OR AP Interpretation:

DATE: 01-AUGUST-2011

Present study since July 29, 2011 shows minimal interval increase in previously reposted hazy densities in the right lower lobe. The previously seen hazy densities are seen in the left lower and right upper lobes are unchanged in status. The rest of the lung fields are clear. The heart remains unenlarged. Rests of the previous findings are unchanged.

XRAY: Chest PA OR AP Interpretation:

Date: 3- AUGUST- 2011

Follow up to the August 1, 2011 study now shows interval decrease in the previously reported hazy densities in the bilateral lower lobes, nmow showing better delineating of the right previously angle. The previously seen hazy densities are seen in the right upper lobes are unchanged in status. The rest of the lung fields are clear. The heart remains unenlarged. Rests of the previous findings are unchanged.

ULTRASOUND: Thorax/ Chest Interpretation:

DATE: 01-AUGUST-2011

Multipalnar scans of the right hemithorax were obtained with the patient in the4 up right sitting position. Free fluid collection is localized in the middle to the lower portion of the right hemithorax with an estimated volume of about 800cc. A wedge shape focus is also noted in the right lower lobe for which atelectasis is not ruled out. Best site for possible thoracenthesis was marked at the posterior right hemithorax with an estimated depth of 5.9 cm from the skin. Patient tolerated the procedure.

29-JULY-2011 Outside of reference range HEMATOLOGY CBC w/ PLT(M) WBC RBC Hemoglobin/ Hgb Hematocrit/ Hct Neutrophils Lymphocytes CLINICAL MICROSCOPY URINALYSIS Color Transparency Pus cells Bacteria Specimen: EDTA, URINE CBC w/ PLT(M) Increased White Blood Cells may be with infections and inflammation. Red Blood Cell decreased with anemia also with Hemoglobin and Hematocrit because this mirrors RBC results. Decrease Hgb and Hct there will be problem in gas exchanged because the Hgb is the responsible for deliveringoxygen to the body. Increase neutrophils because stress acute infection Lyomphocytes decrease, one of the most common causes is an underlying viral infection. 11.7 H 3.39 L 10.9 L 30.4 L 78 H 21L Yellow Turbid* Numerous* Abundant* Reference 5.0- 10.0 4.7- 6.2 14-18 42-52 50-70 25-45

Clear 0-5

URINALYSIS Yellow color indicates pyuria or infection. Turbid urine (cloudy) because of bacterial infection. There were abundant bacteria therefore there were numerous pus cells in the urine.

02-AUGUST-2011 EXAMINATION Physical Color Transparency Chemistry Pleural fluid glucose Pleural fluid protein Pleural Fluid LDH RESULT Yellow SL. Turbid 102.87mg/ dL 3.1 g/dL 329.1 U/L SPECIMEN TRANSUDATE Pale yellow Clear =Blood glucose <=blood protein <200 U/L EXUDATE Cloudy <60mg/dL >blood protein >200 U/L

There was an increase in blood glucose. The pleural fluid protein was an increase and also in pleural fluid LDH. Glucose may indicate an effusion associated with rheumatoid arthritis Transudate pleural effusions are formed when fluid leaks from blood vessels into the pleural space. Exudate pleural effusions are caused by inflammation of the pleura itself Measuring LDH in fluid aspirated from a pleural effusion (or pericardial effusion) can help in the distinction between exudates (actively secreted fluid, e.g. due to inflammation) or transudates (passively secreted fluid, due to a high hydrostatic pressure or a low oncotic pressure) 02-AUGUST-2011 RESULTS HEMATOLOGY Body fluid analysis appearance Yellow fluid with gelatinous materials labeled as pleural fluid. Approximately 500mL 8.00 1.010 8x10^ 6/L 18 80

Total Volume (Body fluid) pH(Body fluid) Specific Gravuty(Body fluid) White Blood cells Segmenters Lymphocyte Eosinophils=2 RBC= occasional Specimen: pleural fluid It is yellow fluid because there are presence of bacteria. The pH is alkaline.

The specific gravity is within normal. There are numerous lymphocyte causes by viral infection and some bacterial infection. Microbiology Acid Fast Bacilli= 0 *they done this procedure to rule out PTB.