62Yrs Diabetic with Expectoration for the past 9 months . No Cough. Slight evening rise of temperature. ESR 102. No past history of Pulmonary TB. No Anoexia or Wt loss. Polymorphs 70 and Lymphocytes 20 . Your Comment ??



Provisional diagnosis :- Pulmonary Koch's with Rt sided Pneumothorax. Advice : - 1) Sputum for AFB and culture and Cytology. 2) Plasma Glucose (F) , (PP) , HbA1C, ADA, LFT, RFT , CRP. Plan :- CECT chest and BAL for Z.N Stain , culture and Cytology. Rx :- 1 ) Glycimic control 2) Water seal drainage under antibiotics coverage of choice. To start ATT as per reports or change plan of management accordingly.

1. Post tubercular bronchi ecstatic Changes with secondary infection. 2. Giant Bullae of middle and lower lobe. 3.Both costophrenic angles are not seen.Mediastinal pleural thickening on the right side present. 4. Mild aneurysm of descending aorta present ( asymptomatic). Suggestion:- Glycemic control and broad spectrum antibiotics, Bullectomy s o s.

Pulmonary koch's with pneumothorax right, advised AKT and under water seal drainage.

Probability of adenocarcinoma lung is high. Probably alveolar variant. Get CECT chest followed by BAL plus biopsy. Pulmonary TB location is atypical for diabetic. Usually seen in lower lobes. Also no much evidence of cavity formation - unusual for TB of 9 month.

Pulmonary Tbc with R sided pneumothorax .ATT And drainage under water seal

Rt lower lobe bulla Bronchiectasis Rt upper lobe; In view of unilateral disease unlikely cause of tubercular aetiology.

There is raised rt horizontal fissure with raised rt dome of diaphragm but the trachea is central signifies rt upper lobe collapse with mass lesion (golden S sign) with rt hilar enlargement .Pt should go for CECT thorax. smoking history should be taken in detail.

sputum afb,bal,cect

rt upper lobe kochs lesion or bronciectasis very unusual for upper lobe to b involved.not sure.get d bronchial secretions fr microscopy,afb n c/s

Pneumonia probably bcoz of klebsiella as pt is diabetic

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