patient 56m was on ATT since 4 months with antibiotics but irregular not responding now came today's xray atteched HIV negative haemogram nad only esr 85 blood sugar normal. dx further



Dr. Kamal.. You are constantly posting good cases... This case shows right lower lobe opacity suggesting of consolidation.. But loss of volume of the right lung with clouding of the ribs suggest associated collapse.. Although cardiac shadow is not shifted.. I suggest to send sputum for AFB smear and bactec culture and gene Xpert plus. And sputum for culture and sensitivity and gram stain smear.. Cect is needed in this patient to exclude any bronchogenic ca as a cause... Bronchoscopy may be needed following cect thorax. Bronchoscopy lavage may be of additional help if AFB smear is negative and malignancy is excluded in CECT There are also scattered patchy opacity both the apex..

Although not looking like a case of pleural effusion.. But associated parapneumonic effusion can be confirmed or excluded by a usg screen

rt. pleural effusion?

hi.. there is surely right lower lobe consolidation with crowding of ribs and shift of trachea to the right,this can be a destroyed lung with pleural thickening/comsolidation.henve patient is a candidate of HRCT Thorax,bronchoscopic lavage to send specimen for sputum Afb,gene xpert,Afb culture sensitivity to see d sensitivity pattern of first line drugs, and to start on cat 2 only if there is resistance or else v can continue d cat 1 with extension.thank u

Rt. Lower zone consolidation with loss of volume sign in Xray Rt side with no improvement with irregular medicine need cect chest followed by bronchoscopy and send lavage for afb smear and culture dst for mycobacterium tuberculosis and Pyo cdst cont. att till report

Possibility of drug resistance, other than 4 ATT levofloxacine may be added and compliance assured before proceeding to ethionamide , kanamycin, PAS etc

get ct scan of chest done non resolving consolidation can be underlying lung carcinoma .there is effusion with consolidation

sputum for AFB should have been done after 2 months of intensive phase of ATT which directs further course of Rx.

bilat apical homogenous shadows & rt. lower lobe consolidation. Needed bronchoscopy BAL & CT SCAN CHEST

must have become a pt. of resistance bacteria. refer to specialist.

RT lobe consolidations HRCT advice with Gene Xpert plus MDR TB ?

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