IMAGE OF THE WEEK

BY Prof . P.VIJAYARAGAVAN‘S UNIT

K.M.JEYABALAJI Ist Yr PG

HISTORYA 40yr old male came with c/o

Right sided chest pain past 1 weekPleuritic in nature

Breathlessness for past 1 weekHemoptyis Occasionally No h/o PND, orthopnoeaNo h/o feverNo other specific complaints

Past history:H/o pulmonary tuberculosis 1 yr back Rx

completedNot a known DM/HT.

Personal history: Not a smoker,alcoholic.

Family history: No specific family history

X RAY

X RAY SHOWSX ray chest PA viewCentraly placed Poor penetrationBone & soft tissue shadows normal

Trachea shifted to leftMediastinum shifted to left

Heterogenous opacities seen in right upper lobe

Right upper lobe pleural thickening seenA sausage shaped hypodensity seen in left

upper and middle zone without vascular markings

Multiple Fibrotic strands with cystic changes seen in left lower lobe

An air fluid level seen in left lower lobeRt side costophrenic angle obliteratedLt side costophrenic angle free

UPPER SECTION

LOWER SECTIONS

CT FINDINGS A thick walled fibrocavity in right upper lobePleural effusion right sideLeft side multiple emphysematous bullae with

interwening septationsLeft lower lobe bronchiectatic changesMediastenal shift to left sideDestroyed lung left side

CONCLUSIONLeft upper & middle lobe emphysematous

bullaeLeft LL bronchiectasisLeft LL cystic changes with air fluid level &

multiple fibrotic strandsDestroyed lung left sideRt side minimal pleural effusionRt upper lobe fibo cavity

DISCUSSIONPRIMARY TB:

Pediatric case- hilar lymphadenopathy (MC) Adult case- Effusion (MC)

PROGRESSIVE PRIMARY TB: Cavity (MC)

POST PRIMARY TB REACTIVATION: Cavity Bronchiectasis Emphysematous bullae Pleural effusion Air fluid level

THANK YOU