64 year old male with complaints of episodic sweating for the last 4 months.Occasional dry cough.No ho fever or weight loss.Non-smoker.Hb 14,wc 14400,esr 35,FBS 114,T3T4TSH normal.

20 Likes

LikeAnswersShare
X ray shows bilateral hilar prominency lymph node enlargement and rt basal consolidation? or pleural pathology? WBC count is increased . Do sputum culture and for AFB. Do ESR. Do glycosylated HB to rule out diabetes. Do Liver function test to rule out liver patholgy giving rise to pulmonary symptoms. Start broad spectrum antibiotics for 7days and see the response.
hyperinflated chest with bilateral lower lobe haziness hrct will give a better picture do sputum or BAL lung causes of episodic sweating include TB lymphoma carcinoid HIV with atypical infections
rt sided basal consolidation leading to shift trenches slightly on rt side,so may b fibrotic changes r started needs CECT for further management
It's not hyperinflated lung filed. Rotation of film is also there. So hilar prominence more appreciated on left side. Basal bilateral lobe Haziness? Cystic Shadows with? copd Picture with dry cough with this age Could have CPFE. Rare though. Hrct thorax is must. Pt could be in LVF too. Diaphragm at normal level. I No Effusion to be considered. Echo to rule out pulmonary hypertension.
what is CPFE
0

View 1 other reply

Episodes of sweating may be related to anxiety as the history is long standing and somebody must have told him pulmonary tb seeing his x ray.. B/l hilar lymphadenopathy with b/l lower zone infiltrates. Going on for a long period definitely consider TB. Sarcoidosis.lymphoma.... At times atypical pneumonia can present like this.. Consider starting him on antibiotics , look for clinical and radiological improvement and simultaneously would get a CT THORAX also, to look for other possibilities.
At age of 64 years, as per his age it is a near normal X-ray. TLC is raised. Find out some othet cause. Had it been consolidation patient would have been symptomatic. No fever,No chest pain, only occasional dry cough are not symptoms of pneumonitis. DO CBC to correlate with increased TLC. Do ECG and echocardiography to find out cause of episodic sweating. Some radiologist in the group can comment on the X-ray
B/l basal infiltrative shadows with h/o fever should be evaluated for ILD. sarcoid is possible need to get MTx and ACE level done. HRCT chest may be considered along with BAL. Will also like to evaluate with BMA for myeloma/ lymphoma and PSA for prostate.
pt is 64 yrs old with episodic sweating with tlc raised and xray showing rt side patchy consolidation so best is iv antibiotics both gram positive and negative coverage for 7days. and pt have to do sputum for afb and ctet
Clinical picture and radiologic findings consistent with Rt basal consolidation. Peripheral Rt lung fields look hazy a diagnosis consistent with an atypical pneumonia.
In rt lower lobe alveolar opacity with fuzzy border ?pneumonia, tb. sputum for AFB and gram stain start emperic ab.
Load more answers

Cases that would interest you