60yrs/M complaints of Multiple bout of haematemesis associated with Difficulty in breathing since yesterday.Previously diagnosed and treated 6mnths for PTB .Vitals BP -150/90,HR -90,Spo2 -92% on RA,RR -22. Labs - TLC -15k,N-70,T.bil - 2.8,Dir.bil-0.8,CRP positive.DIAGNOSIS AND MANAGEMENT PLAN?

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Heterogeneous opacity lt midupper zone Fibrochachiatic scars seen in rt apex H/o multiple bouts of hemoptysis and difficulty in breathing with sp02 92%at RA and TLC suggest leucocytosis Lfts shows ictrus with T bil 2.8 Crp is positive Consolidation with encapsulated effusion of infective aetiology Second possibility Aspergillosis Bilirubininia seems to be induced by antitubercular drugs and need to be evaluated Right not symptomatic treatment to control hemoptysis Adv hrct Sputum for Asperiglesosis

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60/M..case of post primary tuberculosis. Reports suggestive of :cavitation..fibrocalcification with consolidation patch..loss of lung volume to left. leukocytosis with grade one HTN -tuberculosis is progressive in nature looks. -secondary infection of cavities probable. -progressive fibrosis and emphysematous features adding to dyspnoea. -Haematemesis episodes cause need to be evaluated -could be :-erosive gastritis. -esophageal varices -drugs -alcoholic history -investgation: BAL..nucleic acid amplifification test. sputum AFB..HIV status. -RTPCR for covid 19 not to be missed. -to rule out multidrug resistant TB -Management -start on antitubercular drugs with alternate second line drugs like streptomycin..fluroquinolone derivative. -else symptomatic with supportive therapy. -

Thanks for ur appreciation Dr Anjali Mam..
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Collapse consolidation Lt upper mid lobe Cavity Lt upper zone Trachea pulled to Left side ? PTB ?? Malignancy Ad CBNAAT Sputum exam HRCT thorax Biopsy of Left mass upper mid lobe

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CXR..STUDY .. LEFT UPPER LOBE OPASITY .. RT CP..ANGLE OBSCURED .. NEED'S CLINICOPATHOLOGICAL EVALUATION WITH.. HRCT THORAX ..

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,atelectesis of lt upper lobe ? Malignancy at left upper lung ? Trachea shifted to opposite side Hospitalised symtomatic treatment and adv for HDCT for evaluation.

Reevaluate for pul koch But also evaluate for Ca lung Get Ct thorax, endobronchial tissue biopsy Involve pul medicine

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Puln koch,s ? Encysted plural effusion ?? Mass adv CECT chest

ITS CRITICAL CASE SHOWN , PNEUMOTHORAX OCCUR IN LEFT UPPER LOBE OF THE LUNG . ADVICE FOR CHEST HRCT THORAX.

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Pneumonia

Inadequately treated case of bilateral Koch, s.

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