A case of tubercular empyema with pyopneumothorax

Abstract

Pyopneumothorax is a common complication associated with tuberculosis, especially in patients with lung parenchymal cavitatory lesions. In this publication, we highlight the case of a 43-year-old female patient who presented with chief complaints of dry cough, left-sided chest pain, and dyspnea on exertion. An X-ray of the chest posteroanterior (PA) view, revealed a left-sided moderate pleural effusion with pneumothorax. Immediate intercostal chest drain (ICD) insertion was done and a pleural fluid cytology sample was sent which was suggestive of tubercular empyema and the patient was promptly initiated on anti-tubercular treatment to which she responded well and showed clinical and radiological improvements.

Keywords: Adenosine deaminase; anti-tubercular therapy; intercostal chest drain; pyopneumothorax; tubercular empyema; tuberculosis.

Figure 1

Chest X-ray PA view on admission showing right-sided moderate pleural effusion with hydropneumothorax (red arrow showing air-fluid level)

Figure 2

Chest X-ray PA view done post-ICD insertion and drainage of 1000 mL of pleural fluid showing resolution of the left-sided pleural effusion and hydropneumothorax (red arrow)

Figure 3

Chest X-ray PA view on follow-up showing significant resolution of the left-sided pleural effusion after starting anti-tubercular treatment (red arrow)

Figure 4

Chest X-ray PA view after 4 months of anti-tubercular therapy showing near-complete resolution of the left-sided pleural effusion (red arrow)