62 year old female 4 days history of hemoptysis Sputum for CBNAAT - M. TB not detected What to rule out next? Differentials? Ordered a CT-Chest for her.



Extensive fibrotic scars in both lungs Prominent in upper and middle zone, but present all through the lung Few fluffy shadows in middle and upper zone suggest active disease Imp Old tuberculosis causing fibrosis With bronchiectasis Now having recurrence or Superadded bacterial infection

Primarily case appears to be pulmonary tuberculosis as evidently fibrovascular cavity seen in rt apex and reticular fibrosis bilateral Nodular infiltrates in upper zones b/l Lt hilar lymphadenopathy You asked about differentials Yes todays era of corona hence Covid19 pneumonitis 3 malignancy 4 ILD

Thanx dr Ajeet Singh

Heterogeneous opacities with fibrous strands and calcified spots in both the upper and apical lung fields suggestive of OLD PULMONARY KOCH. Recurrent haemoptysis is common in such case. However r/o active KOCH evaluating the pending CT report. May advice for first line LPA of sputum sample. Treat with Tranexamic acid, Amoxycillin or Doxycycline.

@Ajeet Singh , By seeing CxR, fibrocalcified lesions and parenchymal infiltration seen in bilateral lungs with Cavitory lesion present. Suggest Koch's sequele. Get HRCT chest with mountax, esr and CRP, also sputum culture. Sometimes old lesion or newly lesion shows hemoptysis. Age is consider then malignancy is also suspected or bronchiectasis Linokem 600 bd Texakind MF bd Betnesol bd Theoasthalin bd Macbery DX syp Multivitamin

Case of cold(old case of ptb with bilateral fibrosis dystrophic calcification), haemoptysis might be due to Rasmussen anneurhysmal bleeding due to cough,let a hrct chest done


Tnx Dr Ashok Leel sir

Bilateral extensive apical fibrosis Sequel of Koch. Post TB bronchitis

Sequele of pul kochs HRCT chest for better evaluation of cause Post tubercular bronchiactesis and fibrosis

Hrct must Looks bilateral apical Koch's Lt hilar intertristial tb Pneumonia Funga ball Mediastinal tumour Sos broncospic biopsy HP

Pulmonary koch,s

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