Right Lung Fibrosis with Chronic Lung Disease

This is a chest x ray belongs to a 50 years old gentleman who presented with worsening of cough for 2 days duration associated with yellowish sputum production. On examination, he is tachypnoeic with respiratory distress, tachycardic and SPO2 under room air 80%.

Examination of the Respiratory systems reveals clubbing, peripheral cyanosis, no Horner syndrome. Chest examination shows pectus carinatum with reduce chest movement at the right side. The trachea is deviated to right side. Air entry reduced on the right side. Soft crackles at the right upper zone and coarse crackles over the right lower zone. Percussion note is resonance over the right lung zone.

On further questioning, he was previously treated for pulmonary tuberculosis and completed the treatment regime and being well except for on and off shortness of breath.

The Chest X ray shows 1) Hyper inflated lung, 2) Trachea deviated to right site, 3) heterogeneous opacities of the right lung field, 4)loss of cardiac silhouette, 5)obliteration of right costophrenic angle, 6) ? Bullae at right upper-middle lateral lung region.

Based on the history and clinical findings, an impression of chronic lung disease with lower respiratory tract infection, TRO PTB reactivation was made.