CASE SUMMARY

A 59 years old gentleman previously NT/NG,old treated case of Pul.Kochs took ATT in 2009 (at that time diagnosed on CXRAYshowed pleural effusionpleural fluid R/E & C/S confirmed TB) now presented with C/O loss of appetite ------20 days productive cough ------10 days low grade fever ------04 days

 On Examination: Afebrile on presentation BP: 140/90 Pulse: 84/m Chest: Diminshed BS in lower zone Decreased vocal resonance in lower zone Dull percussion note in lower zone Rest of the systemic examination was unremarkable.

 PD: Pleural Effusion Relapse of Tuberculosis

Baseline investigations was sent Blood CP Chest Xray

 Xray Chest showed Pleural effusion

To differentiate between Transudate and Exudate 20 ml of pleural fluid Aspirated and sent to AFIP for Fluid examination Microscopy Fluid for ADA levels

 Further 10 ML of pleural fluid Aspirated and sent to NIH for Gene Expert for Mycobacterium Tuberculosis Which was negative USG Abdomen revealed Pleural Effusion and Consolidation

 Than HRCT chest planned Which showed pleural effusion With collapse lower lobe

 Patient was Refered to Pulmonologist MH Rawalpindi for expert opinion. Where he was labeled as inditerminate Pleural Effusion and advised VATS biopsy drainage