An elderly female with breathlessness

A female aged 70yrs Chief Complaints Gradually increasing Dyspnea Cough Fever(on/off) (x 1 month) History Past history of Pulm Koch's 30 yrs back Physical Examination Resp- Crepts in Rt supraclavicular region

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Rt apical fibrobronchiectatic lesions with tracheal deviation towards right. Hyperinflation sugg of COPD emphysema. Min Left pleural effusion seen. Findings sugg of PTB sequelae with COPD emphysema. Evaluate for active secondary infection and Koch's relapse. Also adv CECT thorax and Echo CD.

There is fibrocavitory changes in rt upper lobe with trachea deviated to rt side. Also Rt hium is pulled upward probably due to fibrosis or post obstructive collapse of upper lobe. - Rt oblique fissure pulled upward. It is convex from below upward. - It could be due obstruction of upper bronchi due to endobronchial obstruction of leads to atelectasis of upper lobe or it could be nass . Do CBC with ESR. Sputum for AFB ( three samples) CBNAAT, chest and Bronchoscopy. - Rt sided diaphragm pulled upward due to fibrocavitory changes in upper lobe or collapse of upper lobe . - Gradual dyspnea could be due collapse of upper lobe due EBTB or mass or due to fibrocavitory changes and loss of volume of rt sided lung

Xray chest PA view shows lt heterogenous nodular opacity in lung parenchyma and fibrosis of rt upper lobe of lung parenchyma and cavity and thickening of middle horizontal fissure. Most likely dx-post koch's sequel with relapse of tuberculosis.with emphysema rt lung. Advise-1-sputum examination for AFB. Cbnatt. Retreat as per reports.

Trachea is pulled to rt Fibrochachiatic lesions rt upper zone and paratracheal region Collapse of rt upper lobe Blunting of lt cp angle Pulmonary tuberculosis with sequele

Copd Ards Old rt apical Koch's Rt basal pneumonitis Hrct cbnat RT PCR Spo2 Reactivation of Koch's Pneumonitis r/0 sarscov2 Trachea shifted rt MDR tb with sarscov 2 pneumonitis

Cavities rt apex Pl effusion rt Reactivation pt

Right upper lobe collapse

Diseases Related to Discussion

Copd
Bronchiectasis
Tuberculosis
Pulmonary Tuberculosis