1. IMAGE OF THE WEEK BY Prof . P.VIJAYARAGAVAN‘S UNIT K.M.JEYABALAJI Ist Yr PG

2. HISTORY A 40yr old male came with c/o Right sided chest pain past 1 week Pleuritic in nature Breathlessness for past 1 week Hemoptyis Occasionally No h/o PND, orthopnoea No h/o fever No other specific complaints

5. X RAY SHOWS X ray chest PA view Centraly placed Poor penetration Bone & soft tissue shadows normal Trachea shifted to left Mediastinum shifted to left

6. Heterogenous opacities seen in right upper lobe Right upper lobe pleural thickening seen A 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 lobe Rt side costophrenic angle obliterated Lt side costophrenic angle free

8. UPPER SECTION

9. LOWER SECTIONS

10. CT FINDINGS A thick walled fibrocavity in right upper lobe Pleural effusion right side Left side multiple emphysematous bullae with interweningseptations Left lower lobe bronchiectatic changes Mediastenal shift to left side Destroyed lung left side

11. CONCLUSION Left upper & middle lobe emphysematous bullae Left LL bronchiectasis Left LL cystic changes with air fluid level & multiple fibrotic strands Destroyed lung left side Rt side minimal pleural effusion Rt upper lobe fibocavity

12. DISCUSSION PRIMARY TB: Pediatric case- hilarlymphadenopathy (MC) Adult case- Effusion (MC) PROGRESSIVE PRIMARY TB: Cavity (MC) POST PRIMARY TB REACTIVATION: Cavity Bronchiectasis Emphysematous bullae Pleural effusion Air fluid level

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