A case for diagnosis - (a)

    This patient was 32 year old. He is a businessman and has two dogs in his farm. He came with cough and right-sided chest pain. Generally he was looking ill with low grade evening fever. He had mild degree of dyspnea. ECG was normal.

O/E
    Right hemithorax is retracted and the chest movement is restricted on the same side. There was generalized dullness over the right lung and no air entry is detected.

Urgent chest x-ray was done (see  pict.)

what do u think the possible diagnosis ?

The x-ray findings (click here)

What investigations done in Rashid Hospital :

 

Rigid bronchoscopy was performed:
   
1- Normal left bronchus tree
    2- Stretched right main bronchus
    3- No blue light reflection from bronchoscope.

CT scan chest was done ( see the picture and findings )

What was done in Rashid Hospital:
    1- Trial of USS guided aspiration with canula  gauge No.18-----> Failed
        cause: very thick fibrous tissues
    

Surgical intervention:

Decision:
    No body expect future expansion of this lung and per-operative consent was taken for right pneumopnectomy.
    Because of extensive fibrous adhesions, the hilum of the lung was difficult to expose. A decision was taken to cancel the procedure.

Operative specimen investigations:
        Parietal pleura was sent for:
           
1- AFB
            2- Microbiology
            3- histopathology

        Fluid sample was sent for:
            1- AFB
            2- Microbiology
            3- cytology


Results of operative specimen investigations:

        1- AFB +++ ve in tissue
        2- AFB +ve in fluid
        3- Histopathology: Auramin stain ----- TB pleurisy
    
4- No evidence of malignancy


Post operative treatment:

Physiotherapy:
One of patient's relatives was a football trainer. He made him make full physiotherapy for 6 months


Chest x-ray after 6 months (see pic.)  showed:

End.