Presentation
Developed sudden dyspnea during hospital treatment of smear positive pulmonary tuberculosis.
Patient Data
right pneumothorax with underlying collapsed right lung, depressed right hemidiaphragm and minimal contralateral shift of the mediastinum
trachea is deviated to the left
no mediastinal widening or cardiomegaly
reticulo-nodular opacities in both lung fields. Fibrosis with bronchiectatic changes at the left upper zone
no pleural effusion bilaterally
no osseous abnormality
Filling defects are seen in the segmental and subsegmental branches of the right lower lobe pulmonary artery as well as lobar and segmental branches of the left upper lobe pulmonary artery, suggestive of pulmonary embolism. No evidence of pulmonary hypertension.
Large right pneumothorax with mediastinal shift and tracheal deviation to the left. Right upper lobe subpleural blebs are observed. Focal communication of the right pneumothorax with adjacent right lung bronchioles, suspicious of bronchopleural fistula.
Reduced left lung volume with left upper lobe cicatrisation collapse, traction bronchiectasis and fibrosis. Diffuse lung nodules with tree in bud appearance are scattered in both lung fields.
Pneumomediastinum is noted.
No evidence of left pneumothorax, bilateral pleural effusion or enlarged mediastinal lymphadenopathy.
Subcutaneous emphysema is seen at the right axillary region and right lateral chest wall.
Case Discussion
This is a typical case of active post primary pulmonary tuberculosis complicated by bronchopleural fistula, right pneumothorax, pneumomediastinum and pulmonary embolism.
Patient was initially admitted to receive treatment for infective and complicated pulmonary tuberculosis. Due to prolonged immobilization in the ward, he also developed pulmonary embolism (confirmed by CT scan).
He was started on anticoagulants and a right chest tube was inserted. He was referred to the cardiothoracic surgeon for further management.
Sputum acid-fast bacillus (AFB) was positive. Mycobacterium tuberculosis was detected by Gene Xpert.
Bronchopleural fistula is a recognized complication of pulmonary tuberculosis (PTB). If a patient with PTB develops pneumothorax and chest drain shows continuous bubbling, a contrast-enhanced CT thorax is indicated to look for a bronchopleural fistula.
Unable to process the form. Check for errors and try again.