M 58 yr Ch smoker c/o sob,fever of and off anorexia, wt loss sputum for AFB negative please interpret xray and DD serial X ray of August 2018, September 2018 and October 2018

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CXR shows COPD emphysema. Rt apical fibrosis,fissural effusion/fibrosis. Rt sided volume loss. 2nd xray sugg,mid zonal fibrobronchiectatic lesion likely superadded bacterial infection. 3rd cxray,sugg mediastinal widening. Needs past history of tuberculosis if any. Ct AKT if on treatment.and ct COPD management.

No h/o Tuberculosis
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Fibrosis collapse with cavitary lesions of the Rt lung with shifting of the mediastinum to the right, right hemi diaphragm raised up, compensatory emphysematous changes in the Lt. Next pneumonia with cavitary lesions in the right. Next widening of the mediastinum, pneumonia increased with cavitary lesions in the Rt, blunt Rt CP angle, mild pleural effusion, cardiomegaly. CBNAAT, repeat sputum for AFB, gram stain and CS. CECT Chest with CT guided biopsy. CBC, RBS, RFT, LFT, 2D-Echocardiography. 1.Pulmonary Koch's . 2 Malignancy

Thanks sir Biopsy taken Awaiting report
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Thank you for the tag sir . In the first xray there collapse causing shifting of the trachea and raised up diaphragm with compensatory hyperinflation of left lung field . In the second xray there is heterogeneous opacity around right hilum. In the last xray as it ap view there is apparently widening of mediastinum and apparent cardiomegaly . As per the discussion it came out that there is no ATT history, in that case there can be obstructive collapse. As patient is old age and smoker need to rule out malignancy. Sir pls get done CECT thorax for the final diagnosis.

Thanks sir Biopsy taken and report is awaited
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Trachea deviated to R .Multiple cavitation get lesions R Lung . R cupola of Diaphragm drawn up .Fibrosis above cavities . Unduly translucent L Lung ? Compensatory Emphysema. Burnt out pulm Tuberculosis. Bronchial lavage for AFB ..what is the result of CBC &ESR ?

Thank you doctor.
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Dear drVedPrakash given xray chest shows fibrovascular cavity in rt mid zone with infiltrates and fibrous strand possibly thickened interlobar septum and loss of lung volume on rt side due to subpulmonic effusion though as you said sputum is negative for afb. But picture presents pultb effusion can be tapped and send for analysis so als go for genxpert or cbnaat yo confirm.this pt will require ATT

Thanks sir
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right sided infilterates with cystic shadows initially same sided shift but may be pleural effusion shifting mediastinum to opposite side; send gene xpert mtb; send sputum c/s to look for secondary infection; good bronchial hygiene with postural drainage needed

I guess the development of the lesion in Right mid zone of lung is more of Fibrotic area with consolidation leading to collapse n loss of volume than any mass leasion... Still i guess CT imaging is def going to help plus negative AFB is a common phenomenon due to low senstivity in microscopic detection....Nevertheless we have option of sending BAL sample which is far more productive than sputum...go for it n send for culture, CB NAAT etc... Rule out Malignancy

Fibrovascular cavity right mid zone with thickened interlobar and lose of lung volume on right side. ? Plural effusion ? Rule out malignancy by advising further investigations like CBNAAT and blood tests and needs careful evaluation and monitoring to conclude for management purpose.

Thank you doctor.
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@Dr. Sandeep Ghodekar @Dr. Rishabh Goel @Dr. Hardik Ahuja @Dr. Kunal Datta @Dr. Ashok Leel @Dr. Isha Garg @Dr. Syam Sundar Patro @Dr. Kunal Datta @Dr. Shivraj Agarwal

Rt lung upper zone collapse nd volume loss with fibrocavitary lesions RMZ..... R/0 PTB... Mediastinal pulling towards right.. Adv sputum CBNAAT.

Thank you doctor.
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