A pto 24yrs having c/o lethargy 2 months. no h/o fever cough ,chest pain. he was unfit for medical check up for a broad. he is working as aluminium cutter for 3years. please discuss the x ray.



Dx :- Aluminosis. X-ray shows diffuse interstitial fibrosis which is mainly located in the upper and middle lobes of the lung along with few nodular opacities. History and X-ray findings consistent with early stages of aluminosis. Advice : 1 ) HRCT chest 2 ) Plasma and Urine - Aluminium level. 3 ) Immunological tests. 4 ) PFT 5 ) To rule out pulmonary koch's as India is endemic for Tuberculosis.

Not looking like tuberculosis.. There is no fever also.. Looks like lung fibrosis induced by aluminium dust. The investigation includes lung function analysis, biological monitoring of Aluminum in plasma and urine and HRCT THORAX. Lung function analysis usually reveals reduced FVC. HRCT findings is usually characterised by small, centrilobular, nodular opacities and slightly thickened interlobular septae.

CXR shows B/L infiltration both UZ, pt is having no cough ,fever,chest pain .Pt. seems to be a case of Pneumoconiosis.However rule out Pulmonary tuberculosis by doing sputum for AFB.

Heterogenous opacities in both upper zones of lung , more in favour of PTB. Advised for sputum microscopy and if negative than CBNAAT to be done. In Aluminosis , heterogenous opacities should cover all the lung field

D/D 1 . Interstitial lung disease. 2 . Pulmonary Tuberculosis. 3 . pneumoconiosis

X ray plate shows bilateral hilar lympadenopathy with patchy consolidation. have a sputum AFB.Maybe pulmonary TB reactivated as there old calcification patch.

CXR s/o b/l uz and mz cystic shadows. No e/o low volume lung to suggest a restictive pathology. Clinically I would like to know past history of lung infections and allergy. Start with routine blood count and r/o anemia as cause of lethargy. Eosinophilia may suggest ABPA and specific igE may be advised. Coming to lung involvement, previous CXR would benefit a lot.. If lesions are new.. Evaluate with an HRCT as bronchiectasis is suspected and we don't want to miss out on early ILD given occupational history. Induce sputum to r/o infectious etiology including sputum for GeneXpert and AFB MGIT, fungal aswell as bacterial culture. If inconclusive consider Bronchoscopy to evaluate the etiology. If still inconclusive a biopsy may be considered. Hope that I have helped. Thank You.

Pneumoconiosis of both upper & midzone with hyperinflation of basis may be due to deposition of aluminium dust leading to restrictive lung disease adv PFT but no specific treatment

this is not tuberculosis.it is a case of diffuse interstitial fibrosis due to metal dust.

Aluminosis diffuse b/l interstitial fibrosis upper zone more

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