Brief Answer:
Top differential remains TB; further workup by HRCT requested.

Detailed Answer:
Hello and Welcome to 'Ask A Doctor' service.

I have reviewed your query. According to the report of xray, patient has infiltrates/cavities & loss of lung volume. These changes usually go with chronic disease process like tuberculosis. As you have mentioned that patient also took antibiotic and still symptoms are persisting so top differential will be TB. Pneumonia not improved with medication should always be followed by workup to rule out other causes. There is quite a possibility that TB test turns out to be negative and still patient is still suffering from the disease. In TB, patient can have adjacent consolidation (pneumonia patch) which will improve after the start of ATT medication. In cases like abscess, gangrene or necrotizing pneumonia, symptoms will be more severe with hemodynamic instability (high grade fever, lethargy, increased vitals signs with altered state of consciousness). If i were treating doctor then i would have advised the patient to under go "High Resolution CT examination of chest (HRCT). This imaging test will give detailed report on lungs, pleura & lymphadenopathy (if present), Further workup/management would be started after the result of HRCT.

Hope I have answered your query. If you have any further questions I will be happy to help.
Wishing you good health !!
Dr. Muhammad Ali Rauf
(Resident Diagnostic Radiology)

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