[Percutaneous drainage of a bulla with tuberculous infection in a patient].

A 63-year-old man complaining of low grade fever and dry cough was admitted to our hospital. Chest X-ray showed infiltrative shadows and a bulla with a fluid level in the left upper lung field. Bacteriological examination of sputum and bronchoalveolar lavage fluid did not yield any diagnostic results. Percutaneous aspiration of the bulla under fluoroscopy was performed. Bulla with tuberculous infection was considered because a high ADA level was detected in the fluid of the bulla. A culture of the bulla fluid was positive for mycobacterium tuberculosis (TB), which was sensitive to all anti-mycobacterial drugs. The fluid in the bulla gradually increased, and occupied the entire space of the bulla three months later. Percutaneous aspiration of the bulla was performed again and a fluid smear was positive for TB. It was thought that systemic administration of anti-mycobacterial drugs had been ineffective, so percutaneous drainage and subsequent injection of anti-mycobacterial drugs into the bulla was performed. The fluid in the bulla subsequently disappeared and the bulla shrank gradually. Percutaneous drainage of a bulla with tuberculous infection should be considered in those who do not respond to medical management.

[Two cases of tubercle bacilli infected pulmonary bulla].

Two cases of tubercle bacilli infected bulla are reported. Case 1; A 78-year-old man visited our hospital complaining of fever and chest pain. The chest radiograph revealed the bulla with air fluid level in the left upper lung field. Mycobacterium tuberculosis was detected in the fluid obtained by percutaneous lung aspiration. He was treated with anti-mycobacterial drugs and showed improvement. Case 2; A 66-year-old man visited our hospital complaining of fever, chest pain and dry cough. The chest radiograph revealed the bulla with air fluid level in the left upper lung field. A diagnosis of tubercle bacilli infected bulla was considered because of high level of ADA in the fluid obtained by percutaneous lung aspiration, and anti-mycobacterial drugs were administered. His symptoms were improved and the frequent chest radiograph showed gradual absorption of the fluid. It is suggested that ADA and bacteriological examinations of the fluid obtained by percutaneous lung aspiration are useful for early diagnosis of tubercle bacilli infected bulla.

[A case of primary amyloidosis with diffuse alveolar hemorrhage].

A 58-year-old man was admitted complaining of hemoptysis and dyspnea. Chest roentgenogram demonstrated bilateral alveolar infiltrates in the middle and lower lung fields. Diffuse alveolar filling shadows were seen on standard chest CT images. His symptoms and pulmonary infiltrates gradually resolved after administration of high-dose corticosteroids and erythromycin. Immunoelectrophoresis showed increased IgM of lambda type. Transbronchial lung biopsy specimens revealed amyloid deposits in the alveolar septa and blood vessel walls. Cervical lymph node biopsy specimen also showed amyloid deposits. The amyloid in this case stained positively with anti-A lambda type amyloid antibody. A diagnosis of primary systemic amyloidosis was made.