Concluded Case

32 year newly married male presented with cough,, dyspnoea,, SOB,, high grade fever with chills (104°F),, generalized weakness and severe headache.. For 4-5 days. -No past significant medical history -took treatment of some local quack for 3-4 days then came to me. O/E -B/l decresed air entry (no air entry left UZ) with gross wheeze and basal crepts -BP 80/40mmhg -HR 120/min -Spo2 80% on air -RR 35/min -Temp 104°F Viral markers are negative. LFT, RFT, WNL ECG is sinus tachycardia CXRPA,, HRCT THORAX,, CBC,, ESR attached. Patient has been admitted in ICU under my care.

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Concluded answer

Left upper and mid zonal fibrobronchiectatic and few destructive lesions seen. Bil diffuse fibronodular opacities seen. Needs to evaluate the type of active secondary infection. As bronchiectatic segment shows area of air bronchogram, and leucocytosis with short duration of high grade fever dyspnea and cough so think of CAP and trea accordingly. Ionotropic support and sos Invasive ventilation. FOB BAL for analysis.

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Left upper and mid zonal fibrobronchiectatic and few destructive lesions seen. Bil diffuse fibronodular opacities seen. Needs to evaluate the type of active secondary infection. As bronchiectatic segment shows area of air bronchogram, and leucocytosis with short duration of high grade fever dyspnea and cough so think of CAP and trea accordingly. Ionotropic support and sos Invasive ventilation. FOB BAL for analysis.

Yes sir... Fully agreed. I too can see a big cavitory lesion in left UZ. Now in my opinion this is ACTIVE PTB with superadded bacterial pneumonitis. So should i strat AKT?
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There is heterogeneous opacity lt upper and mid zone Discreet infiltrates bilateral Hemogram suggest raised esr with leucocytosis predominately granulocytes Hrct also supports xray findings only thing lesion looks cavitory Spo2 80% bcz of loss of lung volume lt side Pt is in hypotension Decrease air entery bcz of consolidation Tachycardia Acute lobar pneumonia Yes iv macrobiotic like meropanum 8hrly Bronchodilators Nebulisation Sos steroids Vasopressors for support

Thank u sir for ur Expert opinion. Just one question... Should i start AKT... Before AFB reports
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Ac lobar pneumonia Fav pts.. High grade fever short history Sob Cough Lt apical region hazy with bronchiectatic lesions Diffuse infiltration both lungs ESR raised /leucocytosis Confirms the diagnosis Sputum for AFB to rule out TB

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Left upper and midzone heterogeneous opacity, with fibrocavitatory lesions Right Para cardiac fibronodular infiltrations + BIL Bronchopneumonia, bacterial . Suggest sputum AFB and CBNATT Antibiotics, nebulizer, mucolytes, ABG , ventilation if needed . IMPRESSION Pneumonia on a pre-existing TB to kept in mind If CB NATT is positive, ATT and broad spectrum antibiotics van be started together

Thank you Dr. AFB sputum and CBNAAT. Sputum culture sensitivity awaited
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LT. SIDED FIBROCAVITARY. LESION HYPERINFLATION..... B / L POSSIBLY.... COPD. EMPHYSEMA P. TB. SEQUELE... WITH SUPERADDED. INFECTIONS ADVISABLE.... 1. SYMPTOMATIC. AND SUPPORTIVE. MANAGEMENT 2. AFTER. C / S.... REPORT.... .... ANTIBIOTICS.... AS. PER. REPORT 3. AKT.... TREATMENT. AFTER. CONFIRMATION..

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Left hilum elevated. Fibrocavitary lesion left upper lung. Hyperinflation of both lungs. Cardiac shadow is tubular. PTB sequel COPD emphysema.

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Thank you doctor
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Left upper& middle cavitory consolidation looks pneumonia with Koch's leucocytosis esr 80 gene expert 3 days sputum for afb culture & sensitivity iv fluid with oxygen

Thank you doctor
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Need to treat as CAP..Ceftriaxome may be a choice. Ionotropic support and SOs ventilator support. Can wait till get the report for AFB to initiate AKT

Thank you doctor
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Heterogeneous opacity on left upper. ? Acute pneumonia ? P. Kock's. Suggest. Sputum AFB & Culture ABG PT INR Anti biotics. Nebulization Brochiodialter If needed. M. Vantilater

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