1/41. Tuberculous empyema. Tuberculous empyema represents a chronic, active infection of the pleural space that contains a large number of tubercle bacilli. It is rare compared with tuberculous pleural effusions that result from an exaggerated inflammatory response to a localized paucibacillary pleural infection with tuberculosis. The inflammatory process may be present for years with a paucity of clinical symptoms. patients often come to clinical attention at the time of a routine chest radiograph or after the development of bronchopleural fistula or empyema necessitatis. The diagnosis of tuberculous empyema is suspected on computed tomography imaging by finding a thick, calcific pleural rind and rib thickening surrounding loculated pleural fluid. The pleural fluid is grossly purulent and smear positive for acid-fast bacilli. Treatment consists of pleural space drainage and antituberculous chemotherapy. Problematic treatment issues include the inability to re-expand the trapped lung and difficulty in achieving therapeutic drug levels in pleural fluid, which can lead to drug resistance. Surgery, which is often challenging, should be undertaken by experienced thoracic surgeons. ( info) |
2/41. Fine needle aspiration biopsy of mastitis secondary to empyema necessitatis. A report of two cases. BACKGROUND: empyema necessitatis is a relatively rare entity. Two instances of mastitis secondary to empyema necessitatis, diagnosed by fine needle aspiration biopsy are reported. CASES: One case was tuberculous in etiology and was initially recognized by cytologic findings of epithelioid and granulomatous cellular reactions and the presence of acid-fast bacilli, which were subsequently cultured and speciated as mycobacterium tuberculosis. The other case was due to coexisting actinomyces and actinobacillus. These organisms were cytologically suggested by "sulfur" granules of filamentous, gram-positive bacilli, admixed gram-negative coccobacilli and Splendore-Hoeppli phenomenon in an exudative cell background and were confirmed by microbiologic culture as actinomyces israelii and Astinomyces actinomycetemcomitans, respectively. CONCLUSION: The usefulness of fine needle aspiration cytology in the diagnosis of empyema necessitatis, supported by ancillary microbial culture, histochemistry, and radiographic imaging, is well illustrated by these two cases. ( info) |
3/41. Epithelioid angiosarcoma arising in the tuberculous pyothorax: report of an autopsy case. Chronic pyothorax associated with pulmonary tuberculosis was recently proposed to be one of the predisposing factors of angiosarcoma arising in the chest wall. Separately, several authors have reported pleural angiosarcoma that has a close resemblance to mesothelioma, the latter having no apparent association with a history of pyothorax. I present a detailed pathologic description of an autopsy case of thoracic angiosarcoma arising after long-standing tuberculous pyothorax, for the purpose of better illustrating this condition. In this case, the main tumor mass was situated on the soft tissue of the chest wall outside the rib girdle. On the pleuropulmonary tissue, tumor infiltration was grossly observable as a dark patch, 2 cm in diameter, on the outer surface of the wall of the pyothorax (pleural peel). Infiltration of the tumor was found in the soft tissue just outside of the peel and in the attached rib. However, the tumor was not found in the peel itself, nor was it found in the necrotic content of the pyothorax. This case suggests that angiosarcoma associated with pyothorax is not similar to primary pleural angiosarcoma and shows the rather ordinary feature of the tumor's arising in the soft tissue. ( info) |
| empyema necessitatis is a rare complication of tuberculous empyema. We present a very rare case of empyema necessitatis into the retroperitoneal space through the diaphragm. The fistula between the thoracic empyema cavity and the retroperitoneal abscess was clearly identified by magnetic resonance imaging. ( info) |
5/41. Tuberculous empyema necessitatis in a man infected with the human immunodeficiency virus. empyema necessitatis is a collection of inflammatory tissue that ruptures spontaneously through a weakness in the chest wail into surrounding soft tissues. Although empyema necessitatis can be caused by a number of infectious agents, mycobacteria are the most frequently implicated. empyema was a much more common complication of pulmonary tuberculosis in the preantibiotic era than it is today. We describe a 22-year-old man with human immunodeficiency virus (hiv) infection who had tuberculous empyema necessitatis and was successfully treated with surgical debridement and antibiotic therapy. ( info) |
6/41. Acquired systemic-to-pulmonary arteriovenous malformation secondary to mycobacterium tuberculosis empyema. Pulmonary arteriovenous malformations (AVMs) with systemic arterial collateralization related to a prior tuberculosis empyema are extremely rare. We report the case of a 15-year-old boy who developed a pulmonary AVM with massive systemic arterial collateralization 5 years after being treated for a mycobacterium tuberculosis empyema necessitans. The AVM was successfully managed with combined intraarterial embolization and surgical resection. ( info) |
7/41. A case of pyothorax-associated lymphoma simulating empyema necessitatis. We describe a case of a diabetic man with a 40-year history of chronic tuberculous empyema presented with fever, chest pain and bulging soft tissue of the right chest wall. CT scan revealed a huge chest wall mass showing extensive necrosis with air-bubbles and destruction of the ribs. Decortication and extirpation of the chest wall mass were performed, and histopathologic examination confirmed diffused large cell type non-Hodgkin's lymphoma. ( info) |
| STUDY DESIGN: Case report with a review of scientific literature. OBJECTIVE: To describe the course of tuberculous spinal disease (Pott's disease) complicated by pyogenic and tuberculous empyema, and chylothorax as there has been an increase in the numbers of notified cases of tuberculosis in the UK(1). To the best of our knowledge, a similar case has not been reported previously in the UK, although there has been a report of bilateral chylothorax associated with Pott's disease. SETTING: A national spinal injuries unit in a Scottish university teaching hospital. methods: review of literature on the chemotherapy of spinal tuberculosis and the role of streptokinase in the treatment of empyema and the relation between spinal tuberculosis, empyema and chylothorax. RESULTS: Although spinal tuberculosis was recognised and treated appropriately with chemotherapy, the patient sustained pleural involvement with later development of both empyema and chylothorax. CONCLUSION: The case highlights the difficulties in the treatment of tuberculosis of the spine inspite of the presence of fully sensitive organisms and early institution of appropriate chemotherapy. In the absence of surgical debridement, the duration and dosage of chemotherapy as practised in the initial period may have to be prolonged into the continuation phase. The thoracic duct can be damaged either because of extension of the tuberculosis itself or because of instillation of intrapleural streptokinase for treatment of pleural empyema leading to chylothorax. There is a need for randomised trials of intrapleural streptokinase treatment in tuberculous empyema. ( info) |
9/41. Pyothorax-associated angiosarcoma of the pleura with metastasis to the brain. Pleural angiosarcoma is an extremely rare, highly malignant neoplasm. Chronic tuberculous pyothorax is one of the etiological factors associated with the development of pleural angiosarcoma. This report details a case of pleural angiosarcoma in a 70-year-old woman with a history of tuberculous pyothorax. Coagulated blood surrounded by thickened pleura in the right thorax and hematoma-like multiple metastases in the brain were noted on autopsy. The pleural lesion was presumed to be the primary site. Microscopic examination revealed rudimentary channels lined by plump neoplastic cells in the coagulated blood of the pleura and the brain. These neoplastic cells stained positive for endothelial markers. A literature review of English language journals revealed this to be the first patient described in detail who developed cerebral metastasis secondary to pleural angiosarcoma. ( info) |
10/41. Combined spinal subdural tuberculous empyema and intramedullary tuberculoma in an hiv-positive patient. Tuberculous involvement of the spinal subdural and intramedullary compartments is extremely uncommon. Simultaneous involvement of both compartments has never been reported, to our knowledge. We present an hiv-positive patient with such kind of combined involvement. diagnosis was made on the basis of a prior history of pulmonary tuberculous infection and a positive therapeutic response to antituberculous chemotherapy. magnetic resonance imaging is the diagnostic procedure of choice in order to determine the exact level, site, and size of the disease. Tuberculosis of the spine should always be considered in the differential diagnosis of spinal cord compression if the patient lives in or comes from a region where tuberculosis is endemic or if the patient is immunocompromised. ( info) |