48 year old ,non smoker male, was diagnosed PTB 3 years ago,On ATT with first line agents, presents with high grade fever,cough and dyspnoea, What does the X ray Chest PA view reveal.

Extensive calcified nodules suggest disease healed long ago. ? cavity left mid zone?

60 year old ,chronic smoker , What is the pattern of this man's emphysema ?

Pan acinar emphysema .Compare this to one of the older images of centrilobular emphysema.

50 year old female presents with chest pain .What is the differential diagnosis?

40 year old male RV positive , reports with progressively worsening dyspnoea, hpoxemia on room air .

Describe the radiological findings, differential diagnosis and next investigations.

Bilateral ,diffuse, reticulonodular infiltrates with perihilar distribution, most likely PCP , other differentials -koch's,LIP, CMV etc .LDH may be raised,Sputum/BAL likely to show PC on SM stain.If inconclusive Tranbronchial lung biopsy may be needed.

42 year old male , diagnosed to have a bad asthma 10 years ago, particularly worse since last 4 years, reports to your clinic with chronic respiratory failure, SaO2 = 70 % on room air, Patient has severe obstruction and restriction on spirometry with partial reversibility.

What does the CT image show ? How will you confirm your diagnosis?

Striking finding is extensive bronchiectasis.This overshadows patchy groundglass opacification.

Also note proximal location of the bronchiectasis.Combined with history of poorly controlled asthma the diagnosis is likely to be ABPA.

21 year old male, presented with fever and cough over 1 month.What is the radiological diagnosis?

How will you confirm it ?

Thick walled cavity and tree in bud type of infiltrates suggest tuberculosis.Sputum AFB should be positive looking at the size of the cavity.

57 year old male, recently detected Diabetes, fever and cough for 1month, received 3 different antibiotics -coamoxyclav,levofloxacin,Cefotaxime with no clinical benefit,Sputum AFB-3 days -negative,No growth on aerobic culture.Diabetes remained poorly controlled despite being on 60 units of insulin./day.What is the DD? How will you investigsate?

DD should include - Fungal infection particularly aspergillus due to necrotization and consolidation , tubercular and bacterial process. Bronchoscopy after lateral Xray/CT thorax to map the lesion will be indicated.

35 year old male, treated for tuberculosis for nearly 2 years.Reports with recurrent hemoptysis and cough with mucopurulent expectorations.He is sputum AFB positive every time he gets tested.His weight is static at 54 kg for past 3 years.What is he suffering from?How will you confirm the diagnosis?

Look at the new image. This is the same patient after a few weeks.Shows complete emptying of the fluid component and empty cavity wall.

Radiologically - first X ray is described as air fluid level within lung parnchyma. Can be seen in a lung abcess / lung cyst.Also notice surrounding lung tissue showed some consolidation - that will be usually seen in a lung abcess.

What is this radilogical pattern called as ? What is your diagnosis?