Pleural Tuberculosis

A Very Unusual Presentation of Miliary Tuberculosis and Osteomyelitis as an Incidental Finding of Musculoskeletal Pain

Tuberculosis (TB) is a highly infectious disease that takes the primary or latent route. In primary TB, the patient often presents with constitutional symptoms such as cough, fever, weight loss, and hemoptysis. This 83-year-old patient was sent to the emergency department (ED) by her primary care physician after abnormal imaging for acute back and neck pain. Imaging revealed pulmonary TB with possible tuberculosis osteomyelitis versus metastatic carcinoma to the cervical vertebrae. The case's unique presentation gives light to the need for more research on miliary TB and tuberculosis spondylitis/osteomyelitis in various populations and circumstances to ensure prompt and adequate patient care.

Open decortication for patients presenting with stage III tuberculous empyema with low density lines on CT imaging

To explore the influence of CT findings on the optimal timing of open decorticationin patients with stage III tuberculous empyema. A total of 80 patients with stage III tuberculous empyema who had undergone open decortications were recruited; 44 patients had chest CT findings indicating low-density lines, while 36 patients did not show this imaging finding. Demographic data, perioperative data and preoperative and postoperative chest CT images were collected. In the low-density line group, the duration of disease (P = 0.0030) and the preoperative anti-tuberculosis time (P = 0.0016) were longer than those of the group without low-density lines, and the ESR (P = 0.0218), CRP (P = 0.0027) and leukocyte count (P = 0.0339) were lower in the low-density line group. Additionally, in the median operative time (P = 0.0003), intraoperative blood loss (P < 0.0001), volume of catheter drainage during 48 h after operation (P = 0.0067), chest tube duration (P < 0.0001), and length of hospital stay (P = 0.0154) were significantly lower in the low-density line group than in the group without low-density lines. A total of 88.64% of participants in the low-density line group showed hyperplasia with hyaline degeneration in pathological examination, which was observed only in 41.67% of patients without low-density lines. In addition, gaseous necrosis was considerably higher in patients without a low-density line (P = 0.004), while the low-density line group had a higher rate of treatment success (P < 0.05). Patients with stage III tuberculous empyema presenting with low-density lines around the thickened fibrous pleural rind on preoperative CT imaging may be good candidates for open decortication.

Pleural Tuberculosis: A Febrile Presentation Without Respiratory Symptoms

Tuberculosis (TB) is one of the largest public health crises globally, with pleural TB comprising a large portion of cases. It has a significantly minimal presence within the United States in comparison to the rest of the world. Awareness of its presence and acumen on diagnostics and treatment are essential. Conventional tests are often time consuming, and do not always yield accurate results. We present the case of a patient presenting with fevers but no cough, who eventually found to have large pleural effusion and concluded to have pleural TB without pulmonary parenchymal involvement. He then showed measurable improvement with empiric treatment.

A Rare Case of Primary Calcific Pleural Tuberculosis - A Case Report

Tuberculosis is a highly prevalent disease in India. It has a myriad of presentations. Usually pleural tuberculosis occur secondary to pulmonary tuberculosis which can manifest as pleural effusion leading to pleural calcification. Primary pleural calcification due to tuberculosis is an extremely rare manifestation of active tuberculosis. We present a case of a 21-year-old female presenting with fever, cough, weight loss and loss of appetite who was diagnosed to have pleural calcification due to primary tuberculosis. We highlight the need to keep primary pleural tuberculosis in mind with above symptoms suggestive of active tuberculosis even when there is no underlying lung pathology.

Outcomes of Video-Assisted Thoracic Surgical Decortication in 274 Patients with Tuberculous Empyema

OBJECTIVE

The present work aimed to retrospectively assess the outcomes associated with decortication by video-assisted thoracic surgery (VATS) in patients with tuberculous empyema.

METHODS

Patients (n = 274) who underwent decortication by VATS for surgical management of pleural empyema between January 2000 to 2010 were included. Pre-, intra-, and postoperative characteristics were observed for all patients, which were followed up for 12 months to evaluate surgical outcomes such as postoperative complications and disease recurrence.

RESULTS

No patients required conversion to thoracotomy, and no death or postoperative bleeding was reported. The mean operation time was 104.5 ± 20.4 min, with 271.5 ± 41.3 ml intraoperative blood loss and median length of hospital stay of 7.2 ± 3 .4 days. Of the 274 patients, 262 were followed up for 12 months; 26 (9.9%) patients showed complications, including incomplete lung re-expansion (11 patients) and persistent air leak (6 patients). While early disease recurrence was observed in 3 (1.1%) patients after surgery, late recurrence was reported for 6 (2.3%) individuals. Interestingly, the complication rate was much higher in patients with chronic empyema (15/34, 44.1%) than in subjects with acute empyema (11/228, 4.8%).

CONCLUSIONS

Decortication by VATS decreases postsurgical complications, and results in decreased disease recurrence. This study demonstrated improved outcomes by decortication by VATS, even in patients with stage III tuberculous empyema.

Pleural tuberculosis in children

Pleural tuberculosis effusion (PTE) in children is a diagnosis which must be considered in isolated pleural effusions in non-toxemic children. It is more common in children over 5 years of age. A history of close contact with an adult with pulmonary tuberculosis reinforces the suspicion for its diagnosis. Pleural effusion without any parenchymal lesion is the characteristic finding on the chest x-ray. However, in 20% to 40% of patients, intrathoracic disease may also occur. Adenosine deaminase, interferon-gamma, analysis of pleural fluid and pleural biopsy are the main tools for diagnostic confirmation. Tuberculin skin test may provide supporting evidence of tuberculous infection. PTE has a good prognosis in children and no long term sequelae are expected.