42 year female patient. C/o fever with cough since three month. Tlc count 10,800.Esr, 58 mm/hr. X ray attached. Dx pls.

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Never start akt before proper diagnosis , first of all only on x-ray , esr , tc can not proove ptb , pls see rbs , hiv test , sputum for Afb , etc x-ray shows rt lower zone pneumonitis with cavitatory lesion so pls do HRCT to r/0 bronchiectsis. Or aspiration pneumonitis. If favours toward ptb than start AKT a/c to wt . Thanx

I very much agree with you. Unless you isolate AFB or can prove by hpe never start att as presumptive treatment. Investigate further ,do a Bronchoscopy and take BAL for analysis, treat with appropriate antibiotics after C/S, bronchodilator s and supportive therapy first.
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Heterogenous opacities right lower lobe. 3 months history is more in favour ofpllppLLpoLOloopLpppp9oppop8pooOppLlpoo8op88pp8popoioopo8ppppoop8opopoppipopoppo8pop8oLop7opppp80opo7ippp6ooooooopolLpooo8p7po7oplplopp7ppppp79l97op7pppp8p97p9po97o7ploLpppi7ppppoppppiP

LUNG ABSCESS RT LOWER LOBE HRCT THORAX SPTUM = C & S CBNATT CULTURE FOR AFB RX ANTIBIOTIC AFTER SENDING SPTUM FOR EXAM TILLOTHER REPORTS ARE AVAILABLE BLOOD = SUGAR HIV

Scoliosis rt basal cavitory lesion with pneumonitis copd cbnat hrct pft Koch's with pneumonitis

3 months history is more in favour of PTB. Advised sputum microscopy for AFB and if sputum is negative for AFB than CBNAAT test is to be done.

Rt lower zone lung heterogeneous opacity with costophrenic angle obliterated. H/o 3 month increases esr goes in favour of tuberculosis.

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The x-ray looks more like left postero-anterior oblique view. There is necrotising pneumonia getting complicated as lung abcess In the right lower lobe.( dt: 25/1/17).

There are soft fluffy infilterates in right lower zone with a cavity.. Taking into account long standing history of fever in the patient Sputum should be sent for AFB detection. Besides pt should also be investigated for any immunocompromised state giving rise to lower zone tb.(diabetes,HIV,immunosupressents,long term systemic steroids). CECT thorax and FOB should also be done to rule out any obstructive lesion.

Sputum for AFB,PT has scoliosis. If AFB negative, CBNAAT. If both negative, Hrct Thorax.

Pneumonitis with cavitation lRLZ.count,sp for AFB,sp go culture and sensitivity,Bl sugar,hiv status to be done

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