Post TB sequelae

34yr old male who givez h/o old tb 9 months back had taken treatment for tb for 3 months Now came with lower left chest pain and cough since 1 week afb negative comment on chest x ray what is approach .

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Left upper zone fibrocavitary disease with encysted left hydropneumothorax. (D/D : Left lower lobe large abscess) As taken ATT for only 3 months previously and defaulted, so, send sputum for CB-NAAT at RNTCP. If hydropneumothorax, Intercostal tube drainage is must, plus give antibiotic (including anerobic coverage). If no lung expansion, take CTVS opinion.
Bull's eye Dada!
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Three months is too short a time for full xray clearance of pulmonary TB.Comparison with previous chest xray is required.If he has developed a recent cough then secondary bacterial infection may be there.In the chest xray apart from tubercular infiltrations there appears to be a ?lung abscess.Sputum for culture and sensitivity and CT thorax may be reqd.
CXR : Left side Costo-phrenic angle not seen, suggestive of Pleural fluid. Fibrosis/thickening of left side Pleura, multiple Cavities of the left upper lobe. Relapse/XDR T.B. HIV has to be R/O. X-pert MTB test is manditory. Treatment with Drug sensitivity is manditary. Dr Brahmananda. -
Fibrocavitry lesion left mid & lower lobe with collapse leading to basal pneumothorax. Suggestive of irreversible changes possibly due to plum kochs aprat from anti kochs treatment if no improvement surgical option should be considered
Streak inlt midzone with fibrotic lesion in lt apex lt hilar prominent with consolidation broncheictasis culture and sensitivity of sputum broncoscopic biopsy HP after hrct looks Koch's treated partialy MDR r/0 lt hydropneumothorax
caviar lesions RUMZ WITH HETEROGENOUS shadows lung.with hydropneumothorax hydro pulmonary tb is a possibility diabetes must be r/o
continue advised sputum for AFB ,RBS THORACOSTOMY TO BE DONE in the Lt lower hemithorax
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will require a CT chest followed by bronchoscopy BAL to rule out superadded bacterial infection or MDR tuberculosis.
lt fibrcavitatry leison plus hydropneumothorax do sp for afb icd on lt side
LMZ consolidation with lt hydropneumothorax ??LMZ abscess
Pleural effusion left, continue AKT.
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