A 48 YRS OLD MALE PATIENT WAS PRESENTED TO THE OPD WITH COMPLAINTS OF OEDEMA AND SHORTNESS OF BREATH CHIEF COMPLAINTS: cough since 6 months shortness of breath since 2 days oedema since 2 days HISTORY OF PRESENT ILLNESS: the patient was apparently asymptomatic two and half months ago when he developed fever, burning micturition, pedal oedema which progressed to anasarca, he was diagnosed with AKI and is on maintainance hemodialysis. 2 days ago he had excurbation of shortness of breath especially during night time, oedema and cough because of which he came to the hospital. HISTORY OF PAST ILLNESS: h/o diabetes since 4 years h/o hypertension since 2 years h/o hypothyroidism since 6 months for which he takes thyronorm 50 mg FAMILY HISTORY: no significant family history PERSONAL HISTORY: married h/o consumption of alcohol occasionally no h/o smoking diet mixed normal bowel and bladder movements GENERAL EXAMINATION: Patient is conscious, coherent and co-operative no audible wheeze/stri