We bronched her and all AFB's are still negative, 6 days later. The TBBX was also negative:
minimal inflammatory cells. Bronchial mucosa and submucosal glands are unremarkable. Alveoli show few pigment laden macrophages. No evidence of granulomas or viral inclusions is seen. AFB stain is ordered, see addendum.
She is currently taking 4 drug TB therapy (after bronch)
What would you do now??
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Actually, I have a question.
This from the RT's notes:
"Pt was extubated per order before mechanic or CPAP gas was up… "
Does this mean the resident gave the order to extubate without know what the blood gasses were?
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She needs a OLB, this could be cavitary lung cancer.
any renal disease? wegeners may present with cavitation... usually larger though-- Fungal stains/cultures of the bx... still wait for tb cultures... think about the new PPD+interferon-gold tests for Tb as well...
almost all diagnostics came out negative. not even for signs of malignancy or tb activity. This could be a dormant tb cavity. Id say observe the cavity for now
Is it contained or is it growing? Is pt. stable, now or is there worry of further compromise? Contained and stable, I agree, watch it and wait on more diagnostics. Unstable and growing leision, take a more aggressive stance. Have they considered thoracotomy?
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