Patient name Mr Raju age 26 years.cook by profession( tandoor man) today vitals spo2%98,pulse60/ minutes,t 94.5•f,BP=110/70 mm of Hg,weight 48 kgs.HAEMOPTYSIS YESTERDAY ONE EPISODE ,no cough ,no weight loss in last six month.good appetite ,hb-14.2,wbc-13100,hot-39.6,rbc-4.85,lymphocytes-34,granulocyte s-59%ESR=10 old case of tb 2/2017.att for two month last year only then Patient lost .he came to me yesterday.belongs to Uttarakhand .sending Xrays films please let me help in treating this patient I am very thankful to all of u.xrays date 5/2/2017,5/6/2017,&15/02/2017 and old usg

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Dissemenated kochs... Pulmonary tb with abdominal tb... Seems that he is a defaulter, better to start on ATT and reasses after 2 months...

Fibro cavitary disease on Right with volume loss. Rule out tuberculosis/MDR tb. Manage hemoptysis conservatively Check coagulation profile as well.. HRCT thorax to check for active infxn Be guided accordingly

Anti tuberculosis drugs should be started.

In an era of Evidence based practice, wont u like to have evidence. Although Xray suggestive of TB, no constitutional s/s of TB yet, clinically dx of Tb still questionable... there r plenty of reasons for hemoptysis. I still believe manage hemoptysis conservatively as it is the 1st episode and try to get evidence while waiting... CBNAAT will hardly take 2hours but blood free sputum specimen.
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I agree with Dr U Sanglodkar

Sequels of tuberculosis... usg showing thickening of cecum and mesenteric lymph nodes... better to start anti tb treatment again...

Pul tub with abd tuberculosis

Useful case discussion .

Dessiminated TB.. defaulter...start cat 2

I thank all of u my colegues who posted me answers of my case

Start ATT cat.2....

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