A male aged 44 years , chronic smoker , having cough , mild fever , pain left side of chest , marked weight loss since 2 months. Comments on X-ray D/ D , Investigations and management.



It appears tobe an xray with barium swallow, probably oesophago- bronchial fistula due to carcinoma bronchus and aspiration pneumonia and lower lobe left side consolidation, probably anaerobic or mixed. Investigations --CT chest, bronchoscopy, sputum cytology, grams stain, sputum cultures, complete blood count, blood sugar, bronchography etc to confirm diagnosis. TREATMENT -- broad spectrum antibiotics with anaerobic coverage, and for mixed organisms, surgery if possible, and supportive therapy.

With respect sir.....in bronchs Ca trachea is got deviated to opposite side....but in this case to the same side.....

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There is marked pleurisy on left side indicated by opacity ,collection of fluid and left space is decreased ,that is the reason of breathlessness .Its a c/o pneumonia .Rise of temprature is further due to infection . Management:- Drainage of fluid .With antibiotic cover like Cefuroxime 500 mg b .d with aclofenac And serratiopeptidase T.I.d .

To Dr.Rajesh Gopal Sir where is the fluid mark?costopherinic angle is clear on left,trachea sifted to left....pls help as my senior.

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There is no pleural effusion...merely LZ n MZ consolidation with MZ cavitations with collapsing. If productive cough is present ..jst go for all test for Koch's along atypical cells..as well as CECT chest and if cough is not productive ,, go for BAL..

Patient is having Pulmonary tuberculosis with fibrosis,cavitation Lt. Side with shifting of trachea Lt. side with mild scoliosis. Investigations:- sputum for AFB, CT chest. ATT as a trial.

Dd Bronchogenic carcinoma Bronchoesophagial fistula Fibrocavitory kochs superimposed with middle zone consolidation as cardiac shadow is hidden.. Need HRCT chest Cbc, ESR, c reactive protein.. sputum for afb and CBNAAT/BACTEC Sos bronchoscopy for further evaluation of any obstruction or fistula.. Rx Cefuroxime iv bid Paracetamol for fever sos Inj.Deriphylline iv bid Proped up position Nebulisation with Asthaline plus budecort..

lt lower lobe consolidation with lt pleural effusion, manage with inj coamoxyclav for days after drainage of collection. manage dyspnoea with xanthine, nebulization with beta 2 agonist

Network fail Pl add. .have sputum afb, cbnat, cbc, HCRT chest, dx pulmonary Koch. ..rx AKT under rntcp guide line with cat 1 regime, follow up. Advice for stopping smoking and dietary supplement. ..

L L L collapse consolidation with compensatory emphysema of RT. Lung , a chronic smoker, weight loss and most importantly Lt. Sided chest pain due to chest wall involvement, my first diagnosis will be to rule out malignancy ( bronchogenic CA). Investig CXation include Hrct, bronchoscopy,and biopsy, or Ct guided F N A C ,to clinch a histopathological diagnosis.

X-ray is over penetrated. Rotated towards left . Left sided lung mass with cavity inside and left 9th rib eroded inferoir border at posterior aspect. History together with X-ray picture indicates bronchogenic carcinoma with secondary infection. Few calcified LN. Should be directed to CECT thorax and CT guided FNAC/ Tru-cut biopsy from lung mass.

Thanks Dr Arnab Sit ..you have very nicely noted the 9th rib erosion. Patient is refferd for CT guided FNAC .

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There things shall provide enough information to make a final diagnosis,.until pt must b given ATT empirically with sm higher A/B like pipracillin or meropenem with tergocid...even clarithro not bed with higher a/b

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