11/41. Miliary tuberculosis as a cause of acute empyema. adult respiratory distress syndrome (ARDS) and sepsis are known, life-threatening complications of miliary tuberculosis. This report describes a patient with miliary tuberculosis who rapidly developed an acute tuberculous empyema. She had a fulminant course culminating in ARDS, sepsis and subsequent death. This case highlights the rare association of acute empyema with miliary tuberculosis. ( info) |
| Childhood tuberculosis might have unusual clinical presentation. A seven-year-old female patient was admitted with fever and pleural effusion. Her pneumonia resolved following 21-day treatment period. An atelectatic appearance remained on the right middle zone in her chest X-ray. tuberculin skin test showed 13 mm induration. Triple drug antituberculosis treatment was started. Since atelectasis persisted on her follow-up radiograph one month later, bronchoscopy was performed which revealed a hemorrhagic polypoid mass occluding the right upper lobe anterior segment orifice. Surgical removal was performed by right upper lobectomy. The pathological diagnosis was necrotizing granulomatous infection suggesting tuberculosis. The patient has been well on follow-up after completing a nine-month course of antituberculous treatment. ( info) |
13/41. CD20-negative pyothorax-associated B cell lymphoma. We describe an 86-year-old male who developed CD20-negative pyothorax-associated B cell lymphoma 64 years after he had suffered from tuberculous pleuritis. Therapy with 8 courses of THP-COP at 2-week intervals was followed by involved-field radiotherapy of 30 Gy. Uncertain complete remission was achieved. Thereafter, local recurrence of pyothorax-associated lymphoma (PAL) at the primary site was seen. The patient received salvage radiotherapy of 50 Gy. The patient died of pneumonia during a second uncertain complete remission. The progression-free survival and overall survival of this patient were 10 and 15 months, respectively. When compared with the median survival of 9 months reported in the literature, the adverse effect of CD20 negativity on prognosis may not apply to PAL patients with an occasional aberrant phenotype. ( info) |
14/41. Chest wall defect and chronic pleural infection: surgical treatment with thoracomyoplasty and open window thoracostomy. We report a rare case of a 75-year-old hemiplegic man with a chronic pleural infection, a bronchopleural fistula, and a full-thickness defect of the chest. In one operation we performed open-window thoracostomy and pleural decortication as well as reconstruction of the chest defect and reclosure of the bronchopleural fistula with a latissimus dorsi muscle flap. The patient made a good recovery and was sent for rehabilitation in good condition. Surgical treatment was essential to control and ultimately halt the septic process. Use of a muscle transplant in a hemiplegic patient did not reduce mobility. ( info) |
15/41. Isolated partial deficiency of adrenocorticotrophic hormone. A patient with tuberculous empyema who presented with severe hyponatraemia, is described. In the course of investigation, he was discovered to be suffering from isolated adrenocorticotrophic hormone deficiency. ( info) |
16/41. Occult tuberculous postpneumonectomy space empyema four years after lung resection. We describe a patient in whom a tuberculous postpneumonectomy empyema developed 4 years after resection for lung cancer. The clinical presentation was dominated by non-specific constitutional symptoms, without any chest complaints. A computed tomographic scan of the chest suggested inflammation in the postpneumonectomy space. Ultimately mycobacterium tuberculosis was cultured from material aspirated by needle thoracocentesis. To our knowledge this is the first report of a tuberculous postpneumonectomy empyema complicating resection for cancer. ( info) |
17/41. Tuberculous empyema necessitatis. Computed tomography findings. Two patients who presented with an anterior chest wall mass were evaluated by computed tomography (CT) scan and were found to have an associated thick-walled pleural collection, consistent with empyema necessitatis. In view of the increasing incidence of pulmonary and extrapulmonary mycobacterium tuberculosis infection, the entity of tuberculous empyema necessitatis should be strongly considered when the described CT findings are present. ( info) |
18/41. Computed tomographic appearance of an oleothorax. Sequelae of oleothorax, formerly used in the treatment of tuberculosis, may still be encountered. A patient is reported whose oleothorax, created 44 years previously, was demonstrated by computed tomography. ( info) |
19/41. Extraosseous 99mTc-MDP uptake in squamous cell carcinoma of the pleura. A rare case of squamous cell carcinoma of the pleura in association with tuberculosis is described. Concentration of 99mTc-methylenediphosphonate was demonstrated in the calcified pleural tumoral tissue. To the best of our knowledge, such concentration has not been previously reported. The possible etiological factors of this disease and findings are briefly discussed. ( info) |
20/41. CT findings in transdiaphragmatic empyema necessitatis due to tuberculosis. A case of transdiaphragmatic empyema necessitatis due to tuberculosis presented clinically as a subcutaneous mass in the posteroinferior right chest. Imaging studies revealed a 12 cm diameter suprahepatic mass contiguous with thickened and calcified right pleura. Even in the preantibiotic era, such a presentation of empyema necessitatis was very unusual. ( info) |