36 year male coal mine worker came to opd with chief complaint of hemoptysis, low grade fever, decreased apetite since last 24 days. diagnosis and management?

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There is bilateral hilar enlargement, right more than left; left Parahilar area show two small areas of ?breakdown; nodular shadows in both lower zones. As he is his exposed to dust at work place, possibility of Pneumoconiosis complicated by Tuberculosis (? Left lingular) is the strongest possibility. Confirm by Sputum AFB, CBNAAT, HRCT Chest. As an epidemiological tool the CXR may be rated against ILO reference plates for objective assessment. Manage by starting Co Amoxyclav, Ethamsylate, Antitussive, Tranquilisers. Then proceed according to investigation reports and clinical response.

Sir thank you for such good input

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Coal mine dust causes a spectrum of lung diseases collectively termed coal mine dust lung disease (CMDLD). These include Coal Workers’ Pneumoconiosis, silicosis, mixed dust pneumoconiosis, dust-related diffuse fibrosis (which can be mistaken for idiopathic pulmonary fibrosis), and chronic obstructive pulmonary disease. Treatment of CMDLD is symptomatic. Those with end-stage disease are candidates for lung transplantation. There is no specific curative treatment for CWP or other types of CMDLD.3 Ideally, additional exposure should be limited. This may be difficult for patients without alternative means of support, who may not wish to change their occupations or for their employers to become aware of their health status. Patients should be seen periodically to evaluate for progression and to provide symptomatic support. Complications such as airflow obstruction, respiratory tract infection, respiratory failure/ hypoxemia, cor pulmonale, arrhythmias, and pneumothorax may occur. If there has been significant crystalline silica exposure, clinicians should be alert to the possibility of Mycobacterial infection as a complication. Supportive treatment also includes good general respiratory care. Patients should receive influenza and pneumococcal vaccinations as appropriate.

D/d sarcoidosis. Pneumoconiosis Tuberculosis

Coal workers pneumoconiosis HRCT chest Prevent exposure to coal dust Symptomatic treatment

Bilateral FIBROCAVITARY lesions.. more in RLZ... r/o PTB.

Bilateral Tubercular infiltration Rx AKT4 for 2mths &Then AKT3 for 4mths &Symptomatic treatment as per Requirements

Rt hilar lymphoadenopathy and it lower zone pneumonitis ?Koch lung

D/d 1Sarcoidosis 2 pneumoconiuosis

There is pathy infiltration both midzone of the lungs exclude tuberculosis,sputum A.F.B.,ESR,P.P.D,go for P.F.T.test,if necessary H.R.C.T.Thorax.

May be tuberculosis, but am not in favour of occupational lung diseases unless at least 15-20 years exposure needed and patient is only 36 yrs old.

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