55year old male ex smoker having high fever with cough *10days pl fluid tapped around 500ml suggest diagnose and treatment

69 Likes

LikeAnswersShare

Raised ADA and ESR, Exudative pleural fluid..... PLEURAL TUBERCULOSIS. Raised polymorphs..... ACUTE BACTERIAL INFECTION (May be UTI as urine exam suggest so). Hydrate the patient, treat UTI, Tab UDCA (300) as liver enzymes are elevated. Start Anti Tubercular Drugs once SGOT and SGPT reach baseline, take h/o alcoholism.

I think one should not wait for shot pt to come normal. U can start with hepatic safe regimen n then add R & Z as well.
7

View 2 other replies

Fibrovascular cavity seen on rt upper zone with fibrosis inter lobar fissure on rt mid zone and pleuraleffusion on rt side with collapse oflower lobe rtside with loss of lung volume lt side is hyperinflated. Esr is 79mm ie raised pleural fluid analysis shows increased cell mainly lymphocytes suggestive of pul tb post tapped x-ray chest shows opening of collapsed lower lobewith minimum effusion .to start ATT is advisable but lft are mildly deranged hence to correct the liver function and to put on ATT with monitoring in future.

Thank you doctor.
8

View 30 other replies

Pleural effusion right. Minor fissure is thickened Veiling opacity with thin walled cavity Rt.upp.lung. Left lung field is clear.. Cardiac shadow is WNL.

Thank you doctor.
4

Do Cbnaat for tapped fluid , what about pleural fluid malignant cell and afb report ,I think probably it's missing so do these two things before making final conclusion , yesterday I talked about light's criteria for pf ,definitely all of us are not in habit of going through that criteria ,but I think we must add and utilize that too

Cbnaat is not recommended for pleural fluid. Ref index tb guidelines 2016. If there is any new update/guideline/literature to this please let me know...
5

View 1 other reply

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!

TRACHEA SHIFTED TO RT RT HORIZONTAL FISSURE PROMINENT RTAEX& UPPER ZONE LADDER SHAPED LESION SUGGESTIVE BRONCHIACTASIS OR CHRONIC CONSOLIDATION LT COMPANSATORY EMPHYSEMA

Tubercular pleural effusion bcos ADA>40 and is lymphocyte predominant >60%

Start ATT for pulmonary kochs and treat uti which could be the cause of high grade fever And get an usg done to rule out abdominal tb also which is very common and frequently asymptomatic

Its a case of extra pulm tb as ada is 79 and esr also79 ,post tapped xray suggest opening of partially collapsed lobe with minimal effusion..wait for lft to be in wnl and than start ATT

Thanx dr Ravindernath Mehrishi

Load more answers