Reactivation Mycobacterium Tuberculosis Presenting as Empyema Necessitans 55 Years Following Thoracoplasty

Abstract

We describe the case of a 79-year-old man who presented with an enlarging mass on his chest wall. He had a history of thoracoplasty performed 55 years ago for treatment of pulmonary tuberculosis. The mass was subsequently proven to be the result of empyema neccesitans caused by reactivation tuberculosis. Empyema neccesitans is a well described entity in which an empyema spontaneously decompresses by dissecting into the chest wall and extrathoracic soft tissues. This can occur following necrotizing pneumonia, including pyogenic or tuberculus, or pulmonary abscess. Complications from collapse therapy for tuberculosis can be encountered decades following the surgery, however, empyema necessitans due to reactivation tuberculosis is rare. This case affords the opportunity to review the goals, techniques, and radiologic appearance of thoracoplasty.

Keywords: CT, computed tomography; TB, tuberculosis.

Figure 1A-B

79-year-old man with reactivation tuberculosis and empyema necessitans 55 years following thoracoplasty. PA and lateral CXR demonstrate left upper rib resections, collapse of the left chest wall, opacification and volume loss of the left hemithorax and chest wall calcifications.

Figures 2A-B

79-year-old man with reactivation tuberculosis and empyema necessitans 55 years following thoracoplasty. Axial CT images of the chest show resections of left upper ribs, distortion and collapse of the left upper thorax and apposition of the chest wall to the superior mediastinum.

Figures 2C-D

79-year-old man with reactivation tuberculosis and empyema necessitans 55 years following thoracoplasty. Axial CT images of the chest show the hemithorax opacified with fluid, peripheral lobular areas of high attenuation tissue, and calcification. A subcutaneous abscess cavity is present.