Tuberculosis with necrotizing pneumonia and hydropneumothorax

Case contributed by Dr Muna Mohammad Aljallaf


Presented to the emergency department with three months history of a cough and two days history of fever with loss of appetite. She was hemodynamically stable. On auscultation, there was no air entry on right side of the chest.

Patient Data

Age: 30 years
Gender: Female

Right-sided hydro-pneumothorax with a leftward shift of the mediastinum and consolidation/collapse of the right lung. A right-sided well-defined intrapulmonary cavitary lesion with internal straight air-fluid level suggestive of lung abscess. Left sided lung widespread miliary nodular shadows sparing the lung base.

After chest tube insertion and thoracentesis: Ill-defined opacities in both mid and right lower zone. A radiolucent area in the right upper zone. blunting of the right costophrenic angle. Chest tube on the right side with tip reaching the right apex.

Case Discussion

A chest tube was inserted in the current case presented due to the fact that patient had necrotizing pneumonia complicated by large hydropneumothorax with pleural line >2 cm from the chest wall and risk of developing respiratory impairment or tension pneumothorax. An analysis of the pleural effusion revealed exudative fluid and TB PCR direct detection test was positive for tuberculosis.

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Case information

rID: 46043
Published: 24th Jun 2016
Last edited: 14th Aug 2019
System: Chest
Inclusion in quiz mode: Included

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