76yr old female diagnosed Interstitial lung disease.... Presented with fever breathlessness to casualty After careful examination Culture showed kleibshella ...pneumonia... Later patient was put on antibiotic according to culture report..... No improvent seen Patient still had wheeze and breathlessness and fever Changed the antibiotic to meropenam and colistin Still no improvement is seen Today ct showed image 1 Cavitation???? Fungal ball??? Aspergillosis?? But previous ct and X-rays in 2016 showed cavity too.... Patient is kept on ntg as Bp is 180/100 in titration dose 3ltrs of oxygen.... without tat patient not able to maintain saturation Ecg showed some irregular rhythm was taken advice from cardiologist and put on calaptin tablet 40.... Please suggest further suggestion n opinion



What is 2 decho says Is there any s/o Lv dysfunction Associated pulmonar hypertension Why not put her on digoxin rather than calaptin See is there componet of lv dysfunction as well ....even diastolic dysfunction U may also think of mycoplasma infection and add Clarithomycin Diuretics optinum dose acc to cvp Antifungal Patient may require extensive chest physitherapy Spirometer exercises Rest Bronchodilators Inhaled steroids in inhaler newer trimium Vaccinate Flucanazole fr fungal infection

Thanku sir!!! Sure sir ll try as u told!!! Sir 2decho done one week back Mild diastolic dysfunction noted With EF-65 Anyways I'll repeat the Echo n see!!!

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Please think of progressive lung disease. Symptomatic treatment till investigation s available, propped up position, o2, brochodilators, steroids, PPI, ,nebul@@@ization, high protein diet,adequate hydration, ct chest, c/s sputum,braid spectrum antibiotics, i/ o chart,SpO2 monitor, isolation if possible

@chest physicians n internal medicine physicians, team approach

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If fever persist inspite of antibiotic acc to c/s report better repeat c/s if possible do brochoscopy n collect sample n send for culture,AFB,anerobic blood, fungal blood culture, look for other source of infection bedsore thromboplebitis line if you have femoral line remove n put new in IJV, change Foley , make little neg giving lasix may be component of failure, check pct, bnp, for time beining add antifungle,

Sure sir...thankuu

ILD with aspergilloma in lt mid lobe Start ANTI FUNGAL along with antibiotics along with cardiac trtmt He is having multiple patho Give diuretics as these pts usually have pul htn Brochodilators This is a notch porch case

Thanku sir....yup sir multiple

Trachea shifted to right. Infiltrations right upper lobe. A cavity with a fungal ball left mid zone. Old PTB with mycetoma.

Thanku sir...Ptb lower lobe??? Unlikely na sir???

Ild with fungal ball Give itracomzole 200 bd with antibiotics Also mucolytics bronchodialtor chest physiotherapy will help Manage for airway and maintain saturation As we are giving broad spectrum antibiotics can give short acting steroids also like hydrocortisone

Thanku sir..Exact treatment is given sir now!!!

In this case are we missing something Thickwalled cavities....is it malignancy Thus hypertension is it due to the actopic ACTH even otherwise whats the cause of fungal infection ...whats causing the immunosuppression And was biopsy done for the diagnosis of ILD

Sir malignancy was ruled out as discussed with radiologist....about the cavity...he is of opinion tat it's not malignancy...plz do check the ct images below...Thanku sir!!

Today patient has hypokalemia after lasix??? Potassium 2.2 Fever reduced blood pressure on higher side 180/100...

Cxr of 2016 shows gross elevation of RT dome of diaphragm ? cause ? collapse RT lower lobe . Kindly post the CT images rather than reports for comparison First and foremost the patient needs fob and toileting along with BAL for further management.

Sure sir ll post soon...Thanku

Above two ct images @Dr. Sathya Prakash Sanjeevaiah

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