### 65 years old lady was brought to OPD with the chief complaint of chest pain on and off since 2 years, associated with burning sensation. Fever is present more or less all the time. No history of cough, hemoptysis, weight loss. No other significant history. In CT Thorax, it has been found that patchy consolidation is present in all the lines in both lungs along with subpleural consolidation in both lungs. What should be the next step ???
Get a HRCT chest done along with bronchoscopy and biopsy if some doubtful mass is seen. D/D - Chronic hypersensitive pneumonitis Pulmonary aspergillosis particularly allergic bronchopulmonary aspergillosis Pulmonary histoplasmosis Other fungal infections like blastomycosis, cryptococcosis Alveolar sarcoidosis Also rule out DM. HIV. Hepatitis B. C , on steroid therapy and other immunocompromised states
Is patient having history progressive dyspnea with dry cough because this type of CT findings can be seen in patient of chronic hypersensitive pnemonitis or cellular type of NSIP. If possible pls post the CT films. Also rule out any infective etiology . Next step should be bronchoscopy which will help in narrowing down the diagnosis.
Chronic Dyspnea with chest pain and such findings on CT Thorax of Nodular lesions and consolidations is less common of bacterial pathology... Go for conditions as stated by Dr Yograj... Ruke out all the common Fungal conditions including Histoplasmosis and Aspergillosis... HP is a strong likely PCP Systemic disease like Sarcoidosis Bronchoscopy with BAL adviced
Hrct is not confirmatory given findings and history are not consistent better also post chest xray and cbc esr if sputum is available than smear for zn stainalso look for cardiac reasons ecg and 2decho will help in diagnosis present situation suggest only copd with lung fibrosis.
CT scan contrast with biopsy Bronchoscopy Biopsy & scopic specimen send for AFB, R /M and C /S CBC ESR MT LFT creat urine r /m Chest pain, Burning sensetion, on & off fever 2 yrs _ ? PTB /CA Further management as per report
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May be a case of GERD and aspiration pneumonia is probability. Endoscopy is advised.
Go for more work out CBC ESR BLOOD SUGAR F CXRay, Echo sputum for AFB and CBNNAT (if possible) B/L Apical pneumonitis with fibrosis
HRCT of chest & biopsy needed.
Agree with Dr Rishabh Goel. Adv Bronchoscopy to conclude diagnosis and treatment plan.
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65 year old male, smoker, presented with high grade fever, cough, n weight loss since last 2 months. his WBC were 23000 with shift to left, sputum AFB was negative sputum c&s was not showing any growth (took multiple antibiotics at multiple GPs before getting admitted) ESR 74 CRP 135 RBS 107 SGPT 38 HIV non reactive creatinine 0.85 x ray showed large left upper zone pneumonia He was given Carbapenem, LEVOFLOX, LINEZOLID for 14 days. later repeated CECT THORAX it was showing same size of consolidation as compared to previous CT along with developing abscess. Now planning for BRONCHOSCOPY, BAL & CT GUIDED BIOPSY to rule out TB, MALIGNANCY, etc. He is daily having fever spikes, low appetite. also developed weight loss of 5 kgs in last 1 month. kindly look at CECT images. Give your valuable opinion for further management.
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