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What Does "Opacities RL2, LL2, LM2, LU2" Mean?

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Posted on Wed, 23 Jul 2014
Question: Have pleural effusion and here are my medical details and medicines given by the doctor during last 3 years:

- given akurit 4 (3 tablets after 3 hours from lunch for 3 months) - 29 XXXXXXX 2011 to 29 Sep 2011.
- Then Bicox 300 for 3 months (empty stomach) - Oct 2011 to Dec 2011.
- Then Akurit 4 (4 tablets after 3 hours from lunch for 3 months). - Dec 2011 to Mar 2012
- Bicox 600 and r-cinex 600 (empty stomach) till date. - Apr 2012 to till date i.e, XXXXXXX 2014.

All the medicines were consumed continuously without breaking the course.

Here is what the last xray report says.
- Opacities RL2, LL2, LM2, LU2.
- Pulmonary Koch ? (Xray guy put a question mark)

Here is what the doctor's report based on above xray report:
- Pleural Effusions Opacities both lungs

Can you please put some light on this and suggest what should we do next. As the doctor has asked us to consult some other doctors after 3 years of continuous medication.
doctor
Answered by Dr. Gyanshankar Mishra (10 hours later)
Brief Answer:
You have taken ATT for too long

Detailed Answer:
Hi,
Thanks for posting the query on HCM. After going through your query, I would like to comment the following:

1. You seem to have been treated for tubercular pleuarl effusion. Taking 3 years of continuous ATT for pleural effusion is a bit long. I supposer in the latter half you were taking either Bi cox 600 or rcinex 600 and not both of them at a single time.

2. How are your symptoms ate present? What were your pleural fluid reports at the start of treatment? What was the xray picture then? Do you suffer from any other diseases currently or in the past?

3. You need to get yourself clinicaly evaluated in detail by a Pulmonologist. Some investigations that need to be done now are ESR, Usg Thorax and abdomen, CT Thorax. A non response to ATT (Anti tb treatment), if present requires search for an alternative diagnosis or a drug resistant TB.


I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries.

Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Gyanshankar Mishra (13 hours later)
Thanks for your reply. It was really helpful.

Before replying further on your questions, I just wanted to let you know, how I discovered that I am suffering from Pleural Effusion.

In March 2011 I got ill with fever and during the medication it was found that I am having Typhoid. Doctor treated the Typhoid and during the treatment followed by an Xray he discovered that Pleural Effusion is there (in April, 2011). Also attached is an initial xray for the same (17th April, 2011).

Now here are my answers as per your questions.
1. Yes, you are right. I wasn't taking them together.

2. As of now I don't feel anything affecting me and I feel myself fit and fine. Also my weight has increased back to 64kg from 52kg during Typhoid. However, I don't know what are the symptoms for Pleural Effusion. Fluid was extracted by the doctor initially and has mentioned in the attached initial report highlighted in Red by me (29 XXXXXXX 2011).

Also please refer the attached " Initial Xray report from April 2011.jpg ".

Currently or in the past I didn't have any disease except the Typhoid in the starting of 2011.

3. Thanks for your suggestions and advice for consulting a Pulmonologist and undergoing the tests. We will definitely consider it.

Also have attached the xrays of this year (Jan 2014 and April 2014).

Please advice your further inputs on the basis of these reports. I shall be very thankful to you.

Thanks again.
doctor
Answered by Dr. Gyanshankar Mishra (17 hours later)
Brief Answer:
Pleural thickening seems to have set in.

Detailed Answer:
Hi,
Thanks for the follow up. After going through your follow up reports, I would like to comment the following:

1. In the last 3 years pleural thickening seems to have set in.
2. Immediately a sonography of chest and CT scan of thorax is required. If pleural thickening has developed and there is associated fibrotic changes, then ATT may be stopped under medical supervision.
3. Please visit a Pulmonologist and get evaluated as mentioned above.


I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries.

Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Gyanshankar Mishra

Pulmonologist

Practicing since :2003

Answered : 600 Questions

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What Does "Opacities RL2, LL2, LM2, LU2" Mean?

Brief Answer: You have taken ATT for too long Detailed Answer: Hi, Thanks for posting the query on HCM. After going through your query, I would like to comment the following: 1. You seem to have been treated for tubercular pleuarl effusion. Taking 3 years of continuous ATT for pleural effusion is a bit long. I supposer in the latter half you were taking either Bi cox 600 or rcinex 600 and not both of them at a single time. 2. How are your symptoms ate present? What were your pleural fluid reports at the start of treatment? What was the xray picture then? Do you suffer from any other diseases currently or in the past? 3. You need to get yourself clinicaly evaluated in detail by a Pulmonologist. Some investigations that need to be done now are ESR, Usg Thorax and abdomen, CT Thorax. A non response to ATT (Anti tb treatment), if present requires search for an alternative diagnosis or a drug resistant TB. I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries. Regards Dr. Gyanshankar Mishra MBBS MD DNB Consultant Pulmonologist