An old rikshaw puller with Severe Breathlessness

A male aged 60 years who is a rikshaw puller Chief Complaints Severe Breathlessness Cough with Expectoration Unable to do his work (x 1 month) Physical Examination Resp- B/l coarse crepitations (+)

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X ray chest shows prominent pulmonary artery in right parahilar region This represents central pulmonary arterial dilatation, in addition there is loss of the peripheral pulmonary blood vessels. It is indicative of pulmonary hypertension, caused by probably underlying COPD

Rt paratracheal, parahilar, basal inhomogenous haziness seen. Adv Sputum/ BAL examination to rule out Infective vs neoplastic etiology.

Copd Rt hilar calcified Rt PCR Hrct Cbnat Biopsy HP Looks Koch's

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