RESUMEN
Empyema necessitans is a rare condition where tuberculosis is the most common cause. It can be found in both immunocompromised and immunocompetent patients, especially in endemic areas. We report a case of a 29-year-old male from North Africa, with an enlarging mass on the right thoracic wall. Imaging, particularly CT showed a cystic lesion in the right chest wall communicating with homolateral pleural effusion, compatible with empyema necessitans. It also showed patterns of pulmonary tuberculosis in the right upper lung. Treatment of empyema necessitans is a combination of medical and surgicaltreatment. Our patient underwent a surgical treatment consisting of flattening of the empyema with a Gene X-pert study of the fluid and the shell, followed by an anti-TB treatment. Anatomopathology confirmed the diagnosis of caseo-follicular tuberculosis.
Asunto(s)
Antibacterianos/uso terapéutico , Fístula Bronquial/terapia , Drenaje , Empiema Pleural/terapia , Enfermedades Pleurales/terapia , Neumonectomía/efectos adversos , Fístula del Sistema Respiratorio/terapia , Procedimientos Quirúrgicos Torácicos , Antibacterianos/efectos adversos , Fístula Bronquial/diagnóstico por imagen , Fístula Bronquial/etiología , Fístula Bronquial/mortalidad , Drenaje/efectos adversos , Drenaje/mortalidad , Empiema Pleural/diagnóstico por imagen , Empiema Pleural/etiología , Empiema Pleural/mortalidad , Humanos , Enfermedades Pleurales/diagnóstico por imagen , Enfermedades Pleurales/etiología , Enfermedades Pleurales/mortalidad , Neumonectomía/mortalidad , Valor Predictivo de las Pruebas , Fístula del Sistema Respiratorio/diagnóstico por imagen , Fístula del Sistema Respiratorio/etiología , Fístula del Sistema Respiratorio/mortalidad , Factores de Riesgo , Procedimientos Quirúrgicos Torácicos/efectos adversos , Procedimientos Quirúrgicos Torácicos/mortalidad , Resultado del TratamientoRESUMEN
Dermatofibrosarcoma protuberans is a malignant tumor of the soft tissue which is characterized by local recurrence with an exceptional metastasize, and for this reason, patients with dermatofibrosarcoma protuberans require a long-term follow-up. This clinical case presents a 41-year-old patient, with no pathological history, who has a malignant tumor of the chest wall, with a pulmonary nodule, which appears on the chest computed tomography scan like a well-rounded parenchymal nodule measuring 15 mm in diameter. This case was discussed in the multidisciplinary meeting which concluded that it is a dermatofibrosarcoma protuberans with metastasis of the lung. In the context of these data, it is thought that the pulmonary nodule is of metastatic origin according to the decision of the multidisciplinary meeting, while the final diagnosis was a hamartochondroma, which is a benign tumor of the lung. The interest of this clinical case is to discuss the possible diagnoses of the pulmonary nodule in the context of malignant wall tumor.