45 years male c/o cough with fever for last 17days Chest pain By occupation farmer Personal history smoke biddi 1packet/day for last 25 years Send for sputum AFB Cxr and other reports attached Dx and rx Thank u



Dear Dr Pankaj The x-ray shows Bilateral lesion in the upper lobe with scattered fibrotic Lesion in the right lung.. The right lung shows loss of volume.. Left lung shows compensatory emphysema with a medium to large sized cavitation in the upper zone.. With 2 week fever and full cavitatory lesion.. First diagnosis is active tuberculosis.. Send sputum for AFB smear and bactec culture and gene Xpert plus on two different days.. I should suggest to start ATT if Patient can't afford CT thorax and sputum smear is negative.. Because we can't wait for 6 weeks for the culture report... Other tests like mantaux or tb gold has no value for starting the treatment empirically.. Bronchogenic carcinoma is always a possibility.. But with fever for 2 weeks and a cavitatory lesion TB is always a priority... Thanks

Tubular heart bilateral apical fibrotic lesion active Koch's cbnat anaemia esr85 leucocytosis neutrophilia do hrct expiratory films 2 decho

Rule out tuberculosis and malignancy as changes of copd and chronic smoker go for hrct thorax other wise agree to dr poddar

CXR shows : Rt. upper lobe opacification/Colapse Consolidation Rt. side. with Mediatinal shift to Rt side. Pt. is farmer, with chronic smoker. 1st. Dx : T.B. 2nd. Dx: Ca Lung has to be R/o Dr. Brahmananda.

collapse rt upper lobe. may be TB lung. bagassosis. bissinosis. with actinomycosis. sputum AFB maybe helpful. rx accordingly to dx.

as can be seen from chest xray there is collapse consolidation of upper lobe with high esr suggesting of pulmonary tuberculosis as first diagnosis but malignancy must also be ruled out . do sputum for afb mauntaux test and cect thorax to arrive at diagnosis

xray findings 1- copd lungs 2- mild rotation 3- old kochs? right upper lobe with fibrosis causing mediastinal shift 4- left upper zone cavity lesion 5- tubular heart shadow diagnosis - lrti in post tb bronchiactasis? or recurrence of tb check sputum for AFB 3 days, cs, fungal stain, tb gold sputum for mtb gene expert if afb positive start with simple antibiotics coamoxiclav and azithromycin or clarithomycin if tb positive need atd

Dear Dr Banerjee.. (1)TB GOLD is of no value in diagnosing tb (2) left lung shows compensatory emphysema due to volume loss of the right lung.. We can't call it a COPD lung But you have spotted the lesions present in the x-ray.. Keep on doing...

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do hrct chest, xray show rt upper zone collapse with consolidation with pull on the right side, after hrct we can come to know the cause, till that time give antibiotics and cough supresent

Bilateral pulmonary koch's, advised AKT.

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