70 yr male heavy smoker with acute onset dyspnoea, cough n low grade fever. he was a worker in cement factory. give your differentials n approach.


hyperinflated lung fields, rt lower zone haziness with few calcifications. COPD with pneumonia. malignancy , PE, tuberculosis , pneumoconiosis. requires more evaluation tests. presently oxygen to keep spo2 more than 90%, nebulisation with bronchodilator and ipatropium, antibiotics for CAP with underlying chr. lung disease , fluids and NIV support if oxygenation or work of breathing dont improve
homogeneous opacity rt mid and lower zone. left pleural effusion. dd pneumoconiosis. pulmonary TB. copd. emphysema. rule out sputum AFB. CBNAT. hcrt chest. tt accordingly with O2 inhalation. nebulisation with beta 2 agonists. ipatropium. Broad spectrum antibiotics. iv fluid. follow up with recording of vitals. ..till dx confirmed. ..
Bilateral pulmonary koch's with mild pleural effusion left, advised AKT.
emphysema with fibrosis COPD
Area of consolidation in right lower zone. Fibrosis in left lower zone with tenting of diaphragm. Possibility of Koch's/ malignancy/ pneumoconiosis needs to be considered. CT thorax is suggested for further evaluation.
inj Deriphylline iv stat, inj dexa iv stat.nebulisation if congestion is more Tab acebrophylline 200mg (sr) Tab Amoxclav625 tab mtnl Tab defacort6mg , tab rabez20, syp Amrodil lx 2tsf for 5days
haziness right lower and mid zone, left diaphragm slightly elevated, left costophrenic angle slightly obliterated. may be old Koch's or may be silicosis. Adv CBC, sputum for AFB.
right middle lobe and left upper lobe infiltrates with features of hyperinflation treat as CAP if pt does not respond to CAP treatment to rule out TB by sputum or BAL
Treatment.:Oxygen to keep SATs more than 94%, Bronchodilatirs+Ipratropium on mid-air+antibiotics+CT chest.
chronic bronchitis with emphysema with old pulmonary tb calcifications with right lower zone consolidation
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