A55yrs old female moderately anaemic having c/o breathlessness and dry cough for four month.chest pain and evening rise temp for two month.tlc,dlc normal else raised .one thing more spo2 79% at time of exam. further management and d/d

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Ill defined redio-opaque shadow in mid and lower zones of Rt lung, silhouettes with Rt heart border, air alveologram sign also seen, ill defined infiltrations in mid and lower zones of Lt lung as well, calcified Rt axillary lymph nodes present on Rt side, scattered calcifications in both lungs....looks more of Tuberculosis,

HRCT needed to R/O malignancy,
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multiple bilateral alveolar opacities with consolidation cardiomegaly sputum for AFB fungal stain if negative BAL may be having associated cardiac pathology 2D Echo and BNP HRCT chest will give more clear picture

Very well elaborated by Dr. Shaikh. Pulmonary Koch's Vs Malignancy Vs ARDS. Will need HRCT, ESR, Montoux, sputum for Gram Stain, AFB and Fungal Stain. May need BAL for Cytology as well.

B.l heterogeneous opacity with irregular margin of opacity in rt lower zone.. could be malignancy investigation to be done.. ecg abg.. as pt is having dry cough.. induce sputum and to be sent for afb.. gene expert gram stain culture and cytology look for any other cause of fever ..urine routine.. any lymphadenopathy. cect thorax should be done and if sputum not induced as per ct report. go for bronchoscopy.. bal. and to be send for.afb. gene expert.. gram stain. culture.. cytology and biopsy if it's mass treatment.. bipap support.. bronchodilator.. and prbc to be transfused look for cause of anemia by general blood picture.. Any history of malena is.it turn out to malignant.. breast examination for any lump

calcified lymph nodes seen in xray
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Miliary pulmonary koch's with consolidation right, advised AKT.

Rt lung mass probably ca and metasisis bilaterally from primary lung tumor. Do HRCT lung. Do bronchoalveolar lavage for cytology. Sputum for AFB.

DD: PNEUMONIA TB DISSEMINATED TB NEEDS WORK UP SPUTUM FOR AFB 2 DAYS SPUTUM AFB CULTURE SPUTUM FOR GRAM'S STAIN AND CULTURE MANTOUX CECT CHEST MAY NEED BRONCHOSCOPY IF DIAGNOSIS IS NOT MADE WITH ABOVE INVESTIGATION

Pulmonary tb, or malignancy

Milliary Tuberculosis with rt lower lobe consolidation..needs HRCT.Spt exam

HRCT shall clinch the diagnosis.
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b/l heterogeneous multiple opacities with homogeneous opacity rounded in roz d/d pul.tb with collapse rt lobe ? Mass rll adv. cect chest with ct guided fnac from lung mass

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