43 female.having seasonal cough dyspnea,fever lasts for 2to3 months,on bronchodilators,takes regular influenza vaccine yearly. h/o PTB in 2015,taken complete AKT. routine lab is normal,ct &serial cxrays displayed.sputum AFB negative. plz discuss management.

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Fresh xray of 26 10 18 shows calcified infiltrates in rt lower zone near chestwall with resolving pneumonic patch sequele of pultb with global EF is 50 to 55 % which is main cause of dysponea rather i should call it c/o cardiac dysponea it should be further evaluated . Rx with antibiotics and nebulisation diuretic should be added

Thanx dr Shital Jadav
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Calcified foci and scarring right lower lung. Hyperinflation of both lungs. PTB sequele COPD

Definitely post TB sequelae, PFT to rule out obstructive or restrictive or mixed pattern. If any signs of obstructions, inhaled broncodilators will help. Less efficacy with restrictive pattern but can be tried. Chest physiotherapy should be advised
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Bilateral emphysematous lung field with Bilateral infiltration with nodular opacity. Rule out for Sputum for AFB Sputum for CS Sputum for CBNNAT Sputum for fungal element Most Of the time patient not given proper sputum sample only split in sample. Repeat test for sputum. Broad-spectrum Antibiotics Tab Augumentin 625mg TDs Tab Deriphylline 150mg BD Tab levocet 5mg HS Cough expectorant Cont . inhaler Nebulization Symptomatic and supporting treatment

Think about tropical eosinophilia
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Copd Tree in bud suggest tuberculosis or bronchiolitis Bronchodilator Vaccinations Rehabilitation exercise

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!

Post TB Obstructive airway disease, Recurrence to be ruled out

Copd Rt lwr zn In view of 2..3..month fever tb should be kept in mind

Calcified nodule. RT lower zone.post Tb sequae...Treat as COLD

PTB COPD Hyperinflation of both lungs seen. Calcified foci and scarring right lower lung.

Thanks Dr Shital.
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Bilateral bronchiolitis(tree in bud) with Rt middle lobe multiple calcified nodules...CRP/ESR/ procalcitonin and sputum GeneXpert ,fungal stain and aerobic culture to rule out active infection

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