27,f brought with dyspnea fever cough wt loss anorexia nausea since 2months. spo2,84%,bp 100/60,HR 140/min. poor socioeconomic status,parents died of PTB.sputum sent for evaluation. plz guide approach to this case.




Chronic symptoms of Respiratory disease and history of Weight loss with Severe Anemia(Hb-4.3).... ECG shows Sinus Tachycardia due to underlying Anemia B/L Fibronodular Infiltrations (R>L) with opacity involving Right mid zone is present.. Rule out PTB and Fungal infection Do routine investigations alongwith Sputum and BAL samples

Thanks sir

Infiltrate presents in bilateral upper and middle zone and in right lower zone . Dyspnea is due to severe anemia and diseased lung , tachycardia can also be explained by severe anemia . Urgent blood transfusion is need . As there is also a family history of tuberculosis , so it is bilateral pulmonary tuberculosis with severe anemia . Start ATT as soon as possible and send sputum for cbnaat to rule out drug resistant tuberculosis.

Thanks sir,patient is having dry cough,cant afford FOB. How to evaluate for MDR?.plz guide.

X-ray Chest - fibro cavitary lesion in b/l more in the Rt side. Consolidation /Pneumonia RLZ. Anaemia. Sputum for AFB, if negative then do CBNAAT, these investigations are most important and is totally free in any government hospital. Other investigations, except CT scan chest are done totally free in every government hospital. Sorry, I tell this as you told that the patient is poor. PTB + Anaemia. Blood transfusion +symptomatic treatment + Broadspectrum Antibiotics. ATD to be started soon after sputum for AFB /CBNAAT reports. ECG - sinus tachycardia, regular, 167 bpm, P - Pulmonale, Axis normal, RWP good, ST depression in Inferior leads, lateral leads and chest leads. Tachycardia and Anaemia induced generalised ischaemia + PHTN

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Tracheal pull towards rt without any effusion with thick walled cavity in rt midzone with extensive fibrocavitory leisons more on rt shows recurrence of acute on chronic ptb with anaemia of chronic illness ,spt for afb /cbnaat is advised

Thanks sir,patient is having dry cough,cant afford FOB. How to evaluate for MDR?.plz guide.

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Fibrocavitary lesions with calcified foci both lungs. Old PTB with Aspergillosis.

Severe anemia with failure, Right midzone cavity, infiltrate s to exclude pulmonary tuberculosisand MDR

Provisional Dx-Pulmonary TB with Severe Anemia, enquire about history of long standing Asthma as ABPA must be ruled out, Counsel for Blood transfusion and start ATT if ABPA is ruled out

B/l extensive multicavitary lesions, suggeating ptb with rt lower zone consolidation

Fibrocavitory lesion on both sides of lung PTB,severe anaemia check hiv status

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