Clinicl image description

Mr. X, a 32 year old man (Figure 1) presented in clinic with breathlessness since 1 year despite being on a dual agent inhaler therapy and Ms. Y, a 68 year old lady (Figure 2) was received in emergency in a state of respiratory failure and was intubated. Both patients had a history of pulmonary tuberculosis in past. Spirometric records of Mr. X and Ms. Y showed severe (FEV1 of 32%) and very severe (FEV1 of 28%) obstruction, respectively. Chest radiographs of both patients showed distorted trachea (1), bilateral fibrotic upper lobes (2), pulled up hila (3) and compensatory hyperinflation of lower lobes (4), giving it a characteristic bald vulture appearance (hyperinflated lungs mimicking the wings and pulled trachea as bald neck). Both were diagnosed as Post TB Obstructive Pulmonary Disease (TOPD). The significance of such a radiograph could mean a serious ventilatory defect requiring urgent physician attention and closer follow ups.

Figure 1: Bald vulture appearance labelled

Figure 2: Bald vulture appearance.