A male aged 30 years having Fever, cough and severe pain chest since 10 days. He is a known case of Bronchial asthma and regularly using Budamet 200 rotocaps. WBC is 15400 with raised neutrophils. Comments on X-ray, D/D, management.



Fibro-cavitory lesion of upper lung (Rt ), suggestive of Pulmonary Koch's. Advice : - Sputum for Z. N. Stain.

The cxray shows b/l hyperinflated lung fields indicating poorly controlled asthma. There is a cavity in right upper lobe; with peripheral consolidation with most probably adjacent pleural involvement explaining the pain(pleuritis) Keeping in mind long term use of inhaled steroids TB should be ruled out...

At this stage with raised WBC count,diagnosis will be lung abscess..

Xray-Right mid zone cavity, consolidation. Emphysematous lungs. bronchovascular prominence . Lymph nodes. D/D- PTB. COPD BR. Asthma T/t- AKT,bronchodilators,Antibiotics, PCM,Anti expectorant. Nebulization


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Emphysrmatous chest with consolidation RT mid and upper zones with a cavity/ Lung abcess. Along with the regular investigation get sputum for AFB, HRCT, to localise lesions antibiotics as per C/S , postural drainage. Once pt settles down after initial treatment will need FOB , and assessment.

Fibro-cavitary lesion right upper lung. P.TB.

R upper lobe consolidation with cavity. Sputum c/s AFB Start antibiotics for community acquired pneumonia. Analgesic for pruritus. @


Emphysema with consolidation & cavitory lesion in rt mid zone Diff... pnemonia T.B. Do routine inv with sputum afb,ct Start iv antibiotics and monitor vitals

empysematous lung with patch or cosolidation rt side with high wbc + neutophils looks like Pneumonia Do r/o tuberculosis Antibiotics injectable and anti pyretics

Rt mid zone cavity with seco. I infection Sputum c&s

Rt. Lobar pneumonia. ?? Bacterial or ) mycobacteria . But the elevated WBC in favour of bacterial pneumonia. Sputum for AFB and emperical antib@iotic ( amoxicillin clavulanic or levofloxacin ) and antipyretic ., expectorant with brochodilator. And rehydration.

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