45 year old gentleman with history of on and off fever with chills from past 2 months. He also gives history of productive cough since past 1 month. x ray chest and routine investigations done and have been added for reference.

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Silhouette sign present Homogeneous opacity in left lower zone there's elevation of left dome of diaphragm Unclear/involved cp angle on the left side Shift of mediastinum on the right side.. Following should be done: 1. Usg chest to assess pleura and tapping 2. Cect chest: as there likelihood of malignancy although there is no mediastinal widening, tb remains no 1 possibility 3. Ct chest should be done once therapeutic tapping is done, to visualize the lung pathology better 4. SputumAFB smear, culture and gene xpert is a must

Madam treatment management also explain mam
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Get a sputum AFB n culture.. Cnfrm pleural effusion by usg n do a diagnostic tap Its Mega ESR..seen in only few coditions TB to b worked up on priorty

ESR is high Send sputum for AFB

LT LOWER LOBE CONSOLIDATION ADV = SPTUM FOR C & S AFB .. CB NATT MITOTIC CELLS HRCT THORAX PET CT FIBREOPTIC BRONCHOSCOPY BAL FLUID = AFB C & S CB NATT MALIGNANT CELLS

Send for sputum for AFB and gene expert ..ESR is very high.it's looks like tuberculosis

Tubercular pneumonia Lt lower lobe with pleural effusion test for AFB start ATT

Can't see Lt dome of diaphragm...may be diaphragmatic hernia..get ct chest done

B/l Miliary shadows Predominantly in lower Zones with left pleural effusion ?? Miliary TB ?? PCP HIV screening? Diabetic?

Left complicated parapneumonic effusion ? Tubercular

Unusual opacity to be tuberculosis

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