54yr / M, Ex Smoker, Left 2yr back, non DM, non HTN, presented with h/o Fever for about one month, low grade, O/E: Bilateral creps & Exp Ronchi, Lt>Rt. CBC, FBS and CXR enclosed. Patient is a Paint worker.

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Fibrovascular cavities on lt side chest one is big well defined rt lower lobe and faint cavities lt upper lobe with dense hilar lymphnode .most likely pulmonary tuberculosis.but since pt is painter inhalation of terpentine fumes and chemicals should also be born in mind for d/d like pneumoconiuosis and malignancy

High Leucocytosis and neutrophilia and raised esr are concernes sec inf shoud be treated with Amoxyclav or cefuraxime and after confirmation of pul tb ATT can be started.
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Presence of Anemia with clubbing and round cavitatory lesions in Xray.... A signal of chronic disease ...can be Malignancy or Fungal infection of cavities made by old disease.. Go for CECT Thorax

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Multiple cavities with neutrophilic leukocytosis may be indicative of staphylococcal pneumonia. Give good anti-staph coverage. But never forget to rule out PTB. Send sputum for Gram stain, C/S, AFB smear, CBNAAT and mycobacterial culture. Low grade fever and history for 1 month should keep TB alive in our mind.

Thanks. His Sputum for AFB and CBNAAT are negative. He is also negative for HIV 1&2.
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Multiple cavitatory lesions on left. Send sputum AFB S/o PTB

Thanks. His Sputum for AFB and CBNAAT are negative.
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multiple cavitatory lesions on left with one large cavity with air fluid level with chronic history s/o ptb; send sputum for gene xpert too

Thanks. His Sputum for AFB and CBNAAT both are Negative.
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Case as discribed suggestive of a case of COPD with multiple cavities with secondary infections As said CBNAAT is negative , should also rule out for any melignancy

Thanks Sir.
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Multiple cavitary lesions on left

Send for Genexpert Sputum AFB, Culture HRCT to Rule out Malignancy Antibiotics, Nebulisation, Mucolytics

pulmonary TB to be ruled out . thick walled cavities on lt side maybe asperogillosis.hib 1&2 tobedone

Put pt no ATT and follow dr.Agarwal . Malignancy can't be ruled out.

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