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A 45 yr old male with swelling on both legs and difficulty in breathing

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This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.  Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.  This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment . K.Lahari  Roll no. 61 A 45 yr old male welder by occupation resident of suryapet came to opd with chief complaints of swelling in leg since 2 months and difficulty in breathing since 10 days.  HOPI- Patient was apparently asymptomatic 3yrs ago. Then he developed swelling in both legs till mid thigh and facial puffiness for which he visited our hospital . He stayed here for 6 days and was on medication and his swelling was subsided.  He went back home.  But 10 days later he had again