Q: Plz tell in detail about the report and also if she has active tb or not How much percentage of problem she has Are the lungs damaged severely or not. What treatment she should take Is this due to bp medication stoppage Only symptom is after waking up she has some accumulation in throat and whe she spits through cough it is fresh blood with clots should I go to gastroenterology she does not have any symptom in stomach A: The CT shows old, healed TB scarring plus a few small fresh patches, and nothing severe. It cannot prove whether TB is active, so she needs sputum tests. Her heart scan shows a likely congenital valve problem that is probably not the cause of the bleeding. This is an interpretation of two reports, not a diagnosis, and she needs to be examined by a doctor soon. 1. CT chest report 4 Nov 2026 Finding What it means ------ Fibrocalcific changes fibrotic strands and calcium spots in both upper lobes and the top part of both lower lobes Scarring from a past lung infection, most often old, healed TB. Calcium and fibrosis mean the body walled it off long ago. Small patchy ground-glass opacities in the left lower lobe Hazy areas. These can be mild infection or inflammation. They can also be blood that was inhaled into the lung from bleeding. A few small nodules in the top part of the right lower lobe Small spots, read as mild infective or inflammatory change. TB spread through the airways can look like this, so it needs checking. No mass, no consolidation, no pleural effusion, no pneumothorax, no enlarged lymph nodes, airways open, great vessels normal These are reassuring. There is no cavity, no collapsed or destroyed lung, and no sign of cancer on this scan. 2. Does she have active TB? This report cannot say yes or no. A CT shows structure, not whether the bacteria are alive. The old scars suggest past TB. The new patches could be: - a mild fresh infection including TB reactivation, - a bacterial or viral infection, or - blood inhaled into the lung from the bleeding. Nothing on the CT is a classic sign of advanced active TB, such as a cavity, big consolidation, effusion or lymph nodes. But active TB is not ruled out, especially because she is coughing up blood. She needs these tests to settle it: - Sputum for AFB smear and CBNAAT/Xpert or TrueNat, plus culture. The early-morning sample, which is when she has the throat collection, is the best one to send. - Chest X-ray, CBC, ESR/CRP, and HIV and blood sugar tests. Please do not start TB medicines on your own. The treatment is 6 months, and the test result decides whether she needs it. 3. "What percentage is the problem?" and "Are the lungs severely damaged?" I can't give an honest percentage from a written report. Radiologists don't report one, and any figure I gave you would be invented. - Based on this report, the lungs do not look severely damaged. The scarring is in the upper zones, which is typical after old TB. The fresh changes are described as small and mild. - What the report doesn't show is how well the lungs work. For that she needs spirometry PFT. - A "post-TB lung function" meta-analysis 2025https://pubmed.ncbi.nlm.nih.gov/40412395/ found that people who have had TB often keep some reduced lung function. This is why a baseline test is useful. 4. Echo report heart, which is also important - Apical displacement of the tricuspid valve, 2.0 cm, "? Ebstein anomaly". This is a congenital from birth valve problem. In Braunwald's Heart Diseasehttps://pubmed.ncbi.nlm.nih.gov/, Ebstein anomaly is described as downward displacement of the tricuspid valve leaflets into the right ventricle. The "?" means the cardiologist wants it confirmed. - Dilated right atrium and mild to moderate tricuspid leak TR 2+ to 3+. This follows from the valve problem. - Moderate pulmonary hypertension RVSP 40 mmHg. This is raised pressure in the lung circulation. It is borderline to mild by most numbers, but it matters here. Scarred lungs, low oxygen or the tricuspid problem can each cause it. A 2024 meta-analysishttps://pubmed.ncbi.nlm.nih.gov/38232991/ found pulmonary hypertension is common after TB. - Normal findings: LV pumping EF 60%, RV function TAPSE 2.6, no clot or vegetation, intact IAS no hole between the upper chambers, and no heart-muscle thickening. 5. Is this due to stopping the BP medicine? Very unlikely to be the cause of the blood in her sputum. - Her heart shows no sign of long-standing high BP: the walls are normal thickness 0.9 and 0.8 cm, the left atrium is normal 2.4 cm, and LV function is normal. There is no sign of fluid backing up from the left heart, which would be needed for BP to cause lung bleeding. - High BP more often causes nosebleeds than coughing up blood clots. - The CT shows scarring and mild patches. These are lung causes, not BP causes. Even so, uncontrolled BP is a separate problem and she should check it today. A BP in the severe range about 180/120 or higher, a bad headache, chest pain or blurred vision needs urgent care. Also, a 27-year-old needing BP tablets should have the cause looked into. Please tell me which BP tablet she was taking. Some, like ACE inhibitors, cause cough. 6. Which doctor should she see? A pulmonologist chest physician first, not a gastroenterologist. - Fresh red blood with clots that comes up with a cough is most likely from the lungs or airways. - Blood from the stomach hematemesis usually comes with vomiting and looks dark or like coffee grounds, often with stomach symptoms. She has none. - Blood collecting in the throat on waking can also come from the nose, gums or throat, so an ENT check is reasonable if the chest work-up is clear. - She should also see her cardiologist for the Ebstein question. 7. Likely causes of her bleeding These are the usual suspects, and the doctor will sort them out: 1. Active or reactivated TB. 2. Bronchiectasis damaged, widened airways or fragile bronchial vessels in old TB scars, which are the commonest cause of bleeding after TB. A HRCT would show this. 3. A fungal ball aspergilloma in an old scar. None was reported on this scan. 4. Raised lung pressure pulmonary hypertension. 5. Less commonly, a clot in the lung. The contrast CT did not report one, but the doctor will consider it. 8. What treatment and tests she is likely to need - Tests: sputum AFB, CBNAAT and culture, CBC with platelets, PT/INR, kidney function, ECG, spirometry, and possibly HRCT chest or bronchoscopy if the source stays unclear. - If TB is confirmed: standard 6-month anti-TB treatment under national program supervision. - For the bleeding: a doctor may prescribe tranexamic acid or similar and advise rest. Please don't self-medicate, particularly because of the heart condition. If bleeding keeps coming back, procedures such as bronchial artery embolization can be used. This is a 2025 systematic reviewhttps://pubmed.ncbi.nlm.nih.gov/41286932/. - For the heart: a cardiology review including ECG or Holter, since Ebstein anomaly can go with rhythm problems. This matters especially if she is or plans to be pregnant, so please tell the doctors. Go to emergency right away if she has: - more than about a cupful 100 mL of blood in a day, or bleeding that keeps going, - breathlessness, chest pain, fainting or a racing heart, - bluish lips, high fever or severe weakness. Details that would help me - Her BP readings and which tablet she stopped, and when. - How much blood there is streaks, a teaspoon, or more, how many days it has been happening, and whether there is fever, weight loss or night sweats. - Any past TB treatment, and whether she is pregnant or on blood thinners.
