A rikshaw puller with increasing breathlessness

A male aged 46 years who is a Rikshaw puller Chief Complaints Increasing Breathlessness Pedal edema Cough since 1 month Physical Examination Auscultation - b/l rhonchi

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Bil upper zonal fibrobronchiectatic lesions with emphysematus bullae and left apical cavitatory lesion seen. Findings sugg of COPD emphysema with PTB. Adv Sputum examination. Adv Echo CD to rule out RVF / PAH.

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CXR looks normal,no signs of bronchitis, pneumonia or COAD changes

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Pulm koch,s

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