K/c/o pulmonary Koch completed course 2yrs back... Now complaints of cough fever on off

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Dr satish.. The possibilities are either recurrent non tubercular bacterial infection in a lung which was structurally damaged sequele to tuberculosis 2 years back.. Or a relapse of the tuberculosis.. You may send sputum for AFB smear and bactec culture and gene Xpert on two different days.. Also send sputum for culture and sensitivity and gram stain.. You should order a HRCT thorax to delineate the structural changes in the lungs.. Like post tubercular bronchiectasis.. Which may be the cause of recurrent chest infection... Immunization for influenza and pneumococcal also helps.. In the meantime treat with antibiotics like co-amoxivlav with azithromycin

Cough with fever for more than 3 wks duration may be tuberculosis. So it can be re activation of tuberculosis. X-Ray chest suggests pyo-pneumothorax of left side with caseation of lt hilar lymphnode with cavitation in upper and mid zone and also white shadow in rt upper and mid zone. Further inv CECT chest CBC sputum for AFB EIA HIV 1 and 2 Plasma glucose.

AFB with HRCT & rule out acute or chronic infection by CBC with ESR &HIV
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Volume loss on left side fibrocavitory leison on left upper zone pleural thickening /pleural effusion on left side

old case tb to confirm reactivation go for culture and dst for afb

? Tuberculous pericarditis

The cxr could have been presented in a better way . However the blunted left CP angle,cavitary lesion in the left upper lobe, wooly fibrotic exudates in the right lung are s/o an active disease likely to be reactivation of the earlier Koch ' s. MDR TB. Further work up is necessary which should include HIV ,sputum for AFB and C/S ,TBGold, pleural fluid for ADA &biochemistry along with HRCT Chest . All these help us to arrive at a correct Do. Dr.D.N.Apparow

there are fibrocavitatatory changes in both upper lobes left upper lobe collapse left pleural effusion it looks like acute on chronic infection aspirate pleural fluid

Plural thinking Lt. Infiltration Rt middle zone. Reactivation or recontact.

First we have to rule out reactivation of tb(sputum afb and culture.)

Take cxr left lateral to differetiate effusipn from thickening

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