A 60 year female, housewife, presented with recurrent cough, breathlessness, hemoptysis from the past 20 yrs. Hemoptysis turned severe since 6 yrs., along with expectaration. Her family history is not significant. Patient has typical clubbing of all digits. On examination of chest, there is B/L wasting of muscles and increased hollowness of apical chest, trachea in midline, apical impulse normal in 5 th left ICS. Vocal tactile fremitus decreased on B/L supra and infraclavicular areas, impaired note present. Fine mid inspiratory crepts, not altered with cough. No post tussive suction noted. Bronchial breath sounds present with decreased VR, due to a fungal ball occupying B/L apical fibrocavities. Patient maintaining normal oxygen saturation, but during bouts of Hemoptysis, there is a fall in oxygen saturation, along with breathlessness. Sputum for afb negative at RNTCP (1) culture of fungal elements positive. FOB BAL fluid sent for culture. Aspergillus fumigates is isolated. On Trendelenberg position, CXR revealed B/L apical fibrocavity with fungal ball. HRCT revealed B/L apical fibrocavity with fungal ball with air crescent sign positive on both sides.

A male patient, D. Sanjeev Rao, aged 50 years, lorry driver by occupation, residing at Vijayawada, AP, presented with Rt. sided chest pain, cough, severe breathlessness, low-grade fever since one day. He was admitted in the casualty under emergency condition and was resuscitated with oxygen inhalation. On inspection, trachea was deviated to right side. Chest was bilaterally asymmetrical. Intercostal tube with underwater seal drainage on right side was found. Right side of chest shows loss of lung volume with wasting of muscles, drooping of shoulder, narrowing of intercostal spaces with crowding of ribs. Apical impulse appears to be shifted to right side. On palpation respiratory movements diminished all over the right chest with increased vocal fremitus over the middle of chest and decreased in base. On percussion dull note was present in base, resonant in middle of the chest. On auscultation, amphoric breathing with metallic quality were heard on right side. CVS-S1, S2 present. On percussion, heart borders were in normal limits. ICD tube column moving continuously. CX-Ray PA view with right pneumothorax encysted with thickened pleural margins with right upper lobe collapse. Patient underwent right decortication on 30 th June 2015. Since then lung was not expanded, but landed into continuous air leakage with bronchopleural fistula with persistent right pneumothorax pocket. Patient was diagnosed as hydropneumothorax. 1 on 1-6-15, treated with intercostal tube. 2 drainage, but was failed with occurrence of bronchopleural fistula. 3 Later, he underwent decortication. 1 and presented with persistent pneumothorax. 4 Patient is a known case of type-2 diabetic, on medication with Human Mixtard insulin for the past 5years. Diabetes was under control. Pus from ICD bag sent for culture for AFBnot detected by culture, confirmed by "MycoReal" real time PCR by SRL diagnostic test. KEYWORDSBPSK Modulator, Convolutional Encoder, CORDIC, DS-CDMA/CI, FPGA. HOW TO CITE THIS ARTICLE:Sudeena D, Lal SB, Kolli SKM. The treatment with water seal chest drain (PDU) in type 2 diabetes mellitus patient with right hydropneumothorax of tubercular aetiology with persistent right pneumothorax with BPF after failure of decortication.