A 65-year-old man with h/o asthma was admitted with one week of progressively worsening dyspnea on exertion. He uses an albuterol inhaler for mild intermittent asthma symptoms, but since last week his dyspnea had not been responsive to bronchodilators. He recently underwent right total knee arthroplasty two months prior to this presentation. Chest radiography and CT are shared below. Plz suggest the line of treatment.

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Infiltrates are noted rt apex floppy haziness in apical zone Bumpping of rt dome Lt mid zone to coastal area fibrous strands noted Lt cp angle is blunted Hrct present fibrochachiatic lesions bilateral Pt is k co asthma Overall picture looks to be COPD WITH PULMONARY TUBERCULOSIS WITH LT SIDE MINIMAL PLEURAL EFFUSION

Thanx dr Ashok Leel
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He is severe case of COPD. R/0 valvular heart disease

Tnx
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DDs PTB UIP Fungal pneumonia. Adv FOB BAL examination.

COPD. DD...Pulmonary Tuberculosis..

Pulm koch,s

Severe COPD

Chronic obstructive pulmonary disease/Valvular Heart Disease

PTB Needs further investigations and evaluation to conclude diagnosis and line of treatment.

Thanks Dr Dinesh Gupta
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Tree bird appearance in hrct bilateral Koch's with lt basal pneumonitis do pft looks active Koch's with pneumonitis with ild

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