Concluded Case

28/m pt was diagnosed as pul koch with rt hydropneumothorax in march 2020,ATT was started n ICD was placed.he now comes to ED with c/o fever,severe breathlessness and chest pain.blocked ICD was replaced with new.pt has developed BPF rt side.kindly opine about further management.

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Concluded answer

Right hydropneumothorax Subcutaneous ,mediastinal air seen . Right lung collapse with mediastinal pull to right. ICD to right pleural cavity seen . Left midzone fibrobronchiectatic infiltrations ,suggestive of PT Bronchopleural fistula has been diagnosed . Suggest Continue ATT Broadspectrum antibiotics Nursing patient on the right side for postural drainage . Bronchoscopy to localise BPF and attempt to close with sealant . Pleurodesis with chalk, doxycycline, or bleomycin. If persistent, thoracotomy and repair of BPF.

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Chronic hydropneumothorax on right side, not responding to prolonged ICD insertion Adv - decortication surgery with pleurodesis to expand the collapsed right lung Left lung field shows infiltration in left middle zone digestive of active pulmonary tuberculosis - look for resistant tuberculosis - please do Sputum for AFB culture and sensitivity

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Right hydropneumothorax Subcutaneous ,mediastinal air seen . Right lung collapse with mediastinal pull to right. ICD to right pleural cavity seen . Left midzone fibrobronchiectatic infiltrations ,suggestive of PT Bronchopleural fistula has been diagnosed . Suggest Continue ATT Broadspectrum antibiotics Nursing patient on the right side for postural drainage . Bronchoscopy to localise BPF and attempt to close with sealant . Pleurodesis with chalk, doxycycline, or bleomycin. If persistent, thoracotomy and repair of BPF.

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Possibly MDR TB Thoracic surgeon's opinion regarding intervention if required. 4 th image showing changes of covid pneumonia, perhaps other pts CT thorax. AKT as per culture and sensitivity report.

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CXR STUDY.. RT.. HYDROPNEMOTHORAX.. LT.. INFILTRATIONS.. ? REOCCURRENCE KOCH'S.. ? RESISTANCE KOCH'S.. NEED'S.. SPUTUM STUDY.. C AND S EXAMINATION..

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Left Tubercular right hydropneumothorax with drainage tube

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I think Sir@Dr. Azam Mohd anything wrong about the patient history 28/m and chest X-RAY of 50y/ m. Please correct the history Or investigation reports.

Sir actually it's the fault of xray tech
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Right sided pneumothorax ?kochs Sputum cbnaat advised

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Bronchiectasis

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