29 yr male , fever for 6 month dry cough wt loss pleural fluid lymphocytic ADA100 multiple septation on USG chest further plan of action ?



Young patient. Fever high ADA.. Lymphocytic.. Looks tubercular.. Option.. (1) intra pleural fibrinolytic treatment (2) Video assited thoracosopic debridement and decortication.. First option is cheaper and may work.

Sir what is pleural fibrinolytic treatment?

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first pleural fluid to be investigated for pcr and gene xpert. to confirm tuberculosis.. or if possible better to go for thoracoscopy that will help break adhesion and biopsy of pleura that will increase yield and confirm the case of tuberculosis as icd would be inserted after thoracoscopy.. intra pleural fibrinolytic can be instilled.. and start att as per reports and if thoracoscopy not possible for any reason.. usg guided pig tail insertion in the collection.. maximum pocket and then fibrinolytic instillation..

CXR S/o Left sided Loculated Plural effusion Lymphocytic predominance with ADA 100 is Tubercular origin Advice Thoracoscopy to clear septations and drain Pleural fluid followed by Decortication....

Loculated itself implies chronicity...So have to start AKT...after testing with Gene xpert (Rifamp res)

empyema thoracic left sided insert a icd in the most dependent position with a da of 100 tb is almost diagnostic could try strepokinase 250000 lk iu

to att

it's seems to b tubercular..start att ..n send d fluid for gene xpert too to rule out MDR althogh sensitivity of grnexpert for pleral fluid quite less.for adhesion cn go for fibrinolytic therapy with stk or other fibrinolytic agent..in case if patient is young and no affordability issue cn go for VATS too..

Pulmonary koch's, advised AKT.

just rule out diabetes, HIV & Tuberculosis. If they are not there it's certainly case of Ca lung. PET CT is most reliable technic for perfect diagnosis. serum CEA can help primary leads to detection of lung cancer


Go for thoracoscopy with adhesiolysis and send biology and fluid for AFB culture. Start ATT. Rule out other comorbidities and treat them.


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