Concluded Case

55 nonsmoker male presented with dry cough dyspnea since a year.not associated with fever anorexia etc. farmer by occupation. no clear past h O, PTB BP130/80 SPO2 86%,HR120. on formeterol budesonide combination. left supraclvicular breath sounds reduced. plz discuss and guide.

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Concluded answer
COPD emphysema. bronchoscopic lavage turned out AFB positive, CBNATT Rifampicin sensitive.possibly relapse of PTB.
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Left lung volume loss Left upper zn fi rosed Trachea pulled to left Scan wise Old healed ptb Reactivity may be juged if pt is symptomatic
Thank you doctor
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fibrocavitory Lesion on LT upper lobe with loss of lung volume as trachea is shifted to left. Compensatory emphysema Cor pulmonale- as RA- RV dilated Treatment Formeterol+budesonide continue Add Tiotropium Rotacaps once a day Oxygen at home- as his SPO2-86%_ reduces progression to decompansated cor pulmonale phase Doxophyllin tabs Acebrophyllin tabs Anti fungal- fluconazole once a week Moxifloxacin / macrolide to cover atypical organism Diuretics- Investigate for active Koch’s lesion- ESR, montoux test ( as no past h/o koch’s)
Cxr suggestive of fibrocavitatory lesion of left upper lobe as trachea shifted to same side....Provisional diagnosis COPD with fibro navigator session of LUL with moderate PAH, treatment oxygen inhalation if spo2 less then 90%RA , neb with Duolin 6 hrly . Neb with budecort 12 hrly . Sryp ambrodil 2tsf TDs , tab dytor 5mg 1- OD , plan for vaccination (pneumovax 23 and influvax )
POST TUBERCULAR SEQUALE LT LUNG WITH FIFROSIS TRACHEA SHIFTED TO LEFT EMPHYSEMA RX 1 VACCINATION -- PNEUMONIA INFLUNZA 2 TRIOTROPIUM INHALER 3 LEVOSALBUTAMOL INHALER 4 BREATHING EXERCISE 5 CHEST PHYSIOTHERAPY 6 RECENT OPINION = LONG TERM DOXYCYCLINE 100 Mg BD
Moderate. Pulmonary HYPERTENSION.... RA. and. RV. .... Dilated .....with........ E F ...65.Percent .... Left. Lung. .... upper lobe. .. . Collapse .... Trachea. pulled. to. left.... Fibrotic. Changes. in. Rt. Hilar region... ADVISABLE.... 1. Symptomatic. TREATMENT.. 2. A F B. ....... staining..with Montaux. Test.. 3. C O P D..
Montaux test not necessary
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Haziness with fibronodular infiltrates lt apical zone with trachea pulled to lt suggestive of pul tb though the pt is nonsmoker but ph 50mm is a concerned likely a factor of dysponea over a year hence kochs is to be confirmed and ATT to be started earliest with Diuretic as he has copd with bilateral blunting of cp angles.
Thanx dr Vedprakash Sharma
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Lt lung volume reduced Lt upper zone fibrosis with pulling trachea towards Lt Longitudinal Lt lower cardiac border Rt CP angle slightly obliterated Rt parahilar lymph nodes calcification CT ? Odl healed TB R/0 activity Treatment as usual as per your management Dr Sandeep Sir
Trachea and mediastinum shifted to left. Right hilum elevated. Right CP angle is obliterated Hyperinflation of both lungs. Fibrocavitary lesions left upper lung Cardiac shadow is tubular. PTB sequele COPD.
Lt upper lobe collapse,Old PTB case, emphysema lungs, fibrotic changes in Rt hilar region. Broad spectrum antibiotics like pipzo, bronchodilaters, LABA LAMA, O2, Check for active PTB
Thank you doctor
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Lt upper lobe collapse Shift of trachea towards lt Old PTB
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