Case History : A 65 year old female coming with Difficulty Breathing

A 65 year old female comes to your Acute Medicine OPD complaining of difficulty breathing for last 5 days and productive cough. You are currently taking electives in Asia .She has a fever of 37.5 C. On auscultation, you can hear wheeze in right lung field but reduced air entry in the left lung.

She does have a past history of Asthma and Tuberculosis during adult years.

1 .What are the X ray findings?

2.Which investigations would you like to perform?

3. What is the most likely Diagnosis?

4. How will you manage this condition?

Answers given in comments section.

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1. What are the X ray findings?

Absent left lung / pneumonectomy due to most likely as part of treatment for Tuberculous lung damage.

Hyperinflation of right lung as a result of compensation to left pneumonectomy or due to emphysema or post TB Bronchiectasis.

2. Which investigations would you like to perform?

Chest X ray

Measurements of oxygen saturation

Arterial blood gases

Sputum for AFB and Culture and sensitivity.

ICT TB

Quantiferon TB test

3. What is the most likely diagnosis?

Acute Asthmatic attack

Post TB Bronchiectasis

TB flare up

4.  How would you manage this condition.

In case of Asthma being predominant,

Give regular nebulization Is Salbutamol and Clenil A nebs

Intravenous hydrocortisone

Oxygen

Intravenous antibiotics. Lung Physiotherapy

In case of acidosis on Arterial blood gas, NIV/ Non Invasive ventilation may be needed.

If TB or Bronchiectatsis are predominant specific Anti TB tratment or antibiotics would be needed.