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.
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 ?
- Lung fibrosis
- pleural effusion
- A Pulmonary cyst
- A Pulmonary Neoplasm
The x-ray findings (click here)
What investigations done in Rashid Hospital :
- Mantoux test ---> positive
- Serological tests for Echinococcus granulosus ---> Negative
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
- Exploratory right postero-lateral thoracotomy was performed.
- Very thick fibrous pleura was opened.
- One Gallon of yellow green pus obtained.
- The right lung was small, collapsed and adherent to the mediastinium.
- Manual ventilation showed minimal expansion of few alveoli
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:
Fluid sample was sent for:
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:
- Patient was kept on anti TB treatment:
Pyrazineamide 2gm OD
Rimactazide 300 mg 2 tab OD
Neurobion one tab. OD
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:
- Adequate expansion of right lung.