1. ZARIA THORACIC CLUB MEETINGAHMADU BELLO UNIVERSITY TEACHING HOSPITAL,ZARIA,NIGERIA CASE PRESENTATION:DESTROYED LEFT LUNG

2. CASE REPORT • Hassan Umar • 38yr soldier • Referred from Barau Dikko based on CXR findings. • PC -Recurrent cough x12yr -Haemoptysis x12yr -weight loss x12yr -dyspnoea x3yr

3. Cough-distressing, non paroxysmal, • -greenish, mucoid sputum,50ml/day • -not posture related • Associated with – • -scanty haemoptysis • -low grade fever • -night sweat • -weight loss • -+v contact with PTB pt • -retrosternal dull ache • Dyspnoea-progressive • No prior hx of trauma to the chest.

4. Systemic review • -not contributory • -no jaundice or bone pain • Past medical Hx • -Diagnosed to have PTB • -+v sputum AFB • -Had full 9/12 course of Anti TB • -4 other episodes over 12yr despite adequate treatment • -completed last therapy 6/12 ago. • Not a known Diabetic or Hypertensive pt. • FSHx

5. General physical examination. • Chest-RR-36/min SPO2 97% • -decreased Lt chest expansion • -decreased Lt tactile fremitus • -dull Lt PN, hyper resonant Rt PN, decreased Lt BS • multiple amphoric BS. -Rt BBS, wide spread expiratory rhonchi. • Other Systemic Review-

6. Available invx result- CXR-(7/09/09)-crowded Lt upper rib. -multiple thin walled lucencies Lt lung field. -Patchy opacity Lt lung -hyper inflated Rt lung field. -mediastinal shift to the Lt. -depressed Rt diaphragm.

9. Sputum AFB- -ve • ESR-60mm/hr • PCV-43% • WBC-5.3 ,L-30.8%,N-55.2% P-206 x 10

10. Assessment- Lt Destroyed Lung Syndrome Secondary to PTB - super impossed Bacterial infection • R/oMulti Drug Resistant cavitatory PTB