ABSTRACT
Background: The initial suspected diagnosis in bilateral lower zone lung involvement made clinically can be compared and correlated with the final diagnosis obtained after percutaneous FNA cytology, BAL fluid examination and transbronchial biopsy. Aim: To study diseases presenting with bilateral lower zone shadow on chest radiograph and compare the initial clinical diagnosis to the final diagnosis. Methods: Fifty six patients were studied by routine hematological, sputum and pleural fluid examination along with PCNA and TBNA cytology, bronchial aspirate/ BAL fluid examination and transbronchial biopsy after a detailed clinical history and thorough physical examination. Results: Initially suspected diagnosis included tuberculosis in 32.1% cases, pneumonia in 30.4%, malignancy in 10.7%, pulmonary oedema in 5.4%, bronchiectasis in 8.9%, ILD in 7.1%, TPE in 3.6% and bilateral hydatid disease of lung in 1.7% of cases. The final diagnosis revealed tuberculosis in 25.0% cases, pneumonia in 23.2%, malignancy in 16.1%, bronchiectasis in 8.9%, pulmonary oedema and ILD in 7.1% each, sarcoidosis and TPE in 3.6% each, while pulmonary candidiasis, pulmonary alveolar proteinosis and bilateral hydatid disease of the lung in 1.7% case each respectively. Conclusion: Majority of cases can be diagnosed by a detailed clinical profile along with a chest radiograph. However, FNAC and fibreoptic bronchoscopy are of high value for pathological and microbiological confirmation of the diagnosis and provides a significant yield.